%0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e65844 %T Exploring 97 Years of Aedes aegypti as the Vector for Dengue, Yellow Fever, Zika, and Chikungunya (Diptera: Culicidae): Scientometric Analysis %A Cheong,Yoon Ling %A Mohd Ghazali,Sumarni %A Mat Hashim,Mohd Hazilas %A Che Ibrahim,Mohd Khairuddin %A Amran,Afzufira %A Tiunh,Tsye Yih %A Lim,Hui Li %A Cheah,Yong Kang %A Gill,Balvinder Singh %A Lim,Kuang Hock %+ Biomedical Museum Unit, Special Resource Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Jalan Pahang, Kuala Lumpur, 50588, Malaysia, 60 326162666 ext 2810, cheongyl@moh.gov.my %K relative growth rate %K vector control %K collaboration index %K bibliometric %K Aedes aegypti %K Scopus %K co-occurrence %K author %K dengue %K Zika %D 2025 %7 23.4.2025 %9 Original Paper %J Interact J Med Res %G English %X Background: Aedes aegypti is an important vector that transmits dengue, Zika, chikungunya, and yellow fever viruses. Although research on Aedes aegypti has been conducted for decades, scientometric studies on Aedes aegypti are scarce, are limited to regions, and cover short periods. Thus, there is still a knowledge gap in the current trend, research focuses and directions, leading authors and collaboration, journal and citation impacts, countries, and worldwide collaborations. Objective: The objectives of the study are to investigate the research trend, focus and directions, citation impact, leading authors and collaboration, journals, and countries of the published works on Aedes aegypti to inform the current knowledge gaps and future direction of the control of the vector. Methods: In this study, we searched the Scopus database for articles on Aedes aegypti published from the year 1927 until April 5th, 2024, and included articles, reviews, books, and book chapters that were written in English. A total of 16,247 articles in 160 journals with 481,479 citations were included. Inconsistencies in authors’ names were checked and cleaned using OpenRefine. The data were grouped into 4 periods; years 1927-1999, 2000-2009, 2010-2019, and 2020-2023. The relative growth rate and doubling time of publications were calculated. The analysis was conducted using VOSviewer, R bibliometrics, and citeSpace. Results: The overall RGR was 0.1. Doubling time increased from 9.3 in 1978-1998 to 12.1 in 2000-2009. The main research clusters were “using Wolbachia,” “Dengue Zika,” “worldwide diversity,” “community support,” “larvicidal activity,” “mosquito genotype-dependent,” and “sterile insect technique.” Journal of Medical Entomology was the leading journal (758/16,247, 4.7%). The most cited articles were authored by Halstead SB and team in Science (N=1355) and Kraemer MU and team in eLife (N=1324). The United States (5806/23,538, 24.7%) and Brazil (2035/23,538, 8.6%) were the top countries. Gubler DJ was the top co-cited author (n=2892) from 2000 to 2019. The co-cited author cluster patterns informed the significant specialty research on Aedes aegypti across time. Authors from various specialized research fields tended to collaborate across countries, especially neighboring countries. Countries with more research funding on the study of Aedes aegypti published more papers. Conclusions: Researchers or entomologists could understand the current knowledge gap on Aedes aegypti and plan for future research pathways. This study contributed to the public health stakeholders in improving the vector control interventions and elucidated the extent of research subject areas. %M 40267478 %R 10.2196/65844 %U https://www.i-jmr.org/2025/1/e65844 %U https://doi.org/10.2196/65844 %U http://www.ncbi.nlm.nih.gov/pubmed/40267478 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e54651 %T Policy Spotlight Effects on Critical Time-Sensitive Diseases: Nationwide Retrospective Cohort Study on Taiwan’s Hospital Emergency Capability Categorization Policy %A Lin,Chih-Yuan %A Liu,Chih-Ching %A Huang,Yu-Tung %A Lee,Yue-Chune %+ Institute of Health and Welfare, College of Medicine, Yangming Campus, National Yang Ming Chiao Tung University, Taipei, Taiwan, No.155, Sec.2, Linong Street, Taipei City, 112, Taiwan, 886 225916681 ext 1526, DAS73@tpech.gov.tw %K categorization of hospital emergency capability %K quality %K time-sensitive diseases %K emergency care %K difference-in-differences %D 2025 %7 25.3.2025 %9 Original Paper %J Interact J Med Res %G English %X Background: Taiwan’s categorization of hospital emergency capability (CHEC) policy is designed to regionalize and dispatch critical patients. The policy was designed in 2009 to improve the quality of emergency care for critical time-sensitive diseases (CTSDs). The CHEC policy primarily uses time-based quality surveillance indicators. Objective: We aimed to investigate the impact of Taiwan’s CHEC policy on CTSDs. Methods: Using Taiwan’s 2005 Longitudinal Health Insurance Database, this nationwide retrospective cohort study examined the CHEC policy’s impact from 2005 to 2011. Propensity score matching and difference-in-differences analysis within a generalized estimating equation framework were used to compare pre- and postimplementation periods. The study focused on acute ischemic stroke (AIS), ST-segment elevation myocardial infarction (STEMI), septic shock, and major trauma. AIS and STEMI cases, monitored with time-based indicators, were evaluated for adherence to diagnostic and treatment guidelines as process quality measures. Mortality and medical use served as outcome indicators. Major trauma, with evolving guidelines and no time-based monitoring, acted as a control to test for policy spotlight effects. Results: In our cohort of 9923 patients, refined through 1:1 propensity score matching, 5566 (56.09%) were male and were mostly older adults. Our analysis revealed that the CHEC policy effectively improved system efficiency and patient outcomes, resulting in significant reductions in medical orders (–7.29 items, 95% CI –10.09 to –4.48; P<.001), short-term mortality rates (–0.09%, 95% CI –0.17% to –0.02%; P=.01) and long-term mortality rates (–0.09%, 95% CI –0.15% to –0.04%; P=.001), and total medical expenses (–5328.35 points per case, 95% CI –10,387.10 to –269.60; P=.04), despite a modest increase in diagnostic fees (376.37 points, 95% CI 92.42-660.33; P=.01). The CHEC policy led to notable increases in diagnostic fees, major treatments, and medical orders for AIS and STEMI cases. For AIS cases, significant increases were observed in major treatments (β=0.77; 95% CI 0.21-1.33; P=.007) and medical orders (β=15.20; 95% CI 5.28-25.11; P=.003) compared to major trauma. In STEMI cases, diagnostic fees significantly increased (β=1983.75; 95% CI 84.28-3883.21; P=.04), while upward transfer rates significantly decreased (β=–0.59; 95% CI –1.18 to –0.001; P=.049). There were also trends toward increased major treatments (β=0.30; 95% CI –0.03 to 0.62, P=.07), medical orders (β=11.92; 95% CI –0.90 to 24.73; P=.07), and medical expenses (β=24,275.54; 95% CI –640.71 to 4,991,991.78; P=.06), although these were not statistically significant. In contrast, no significant changes were identified in process or outcome quality indicators for septic shock. These findings suggest policy spotlight effects, reflecting a greater emphasis on diseases directly prioritized under the CHEC policy. Conclusions: The CHEC policy demonstrated the dual benefits of reducing costs and improving patient outcomes. We observed unintended consequences of policy spotlight effects, which led to a disproportionate improvement in guideline adherence and process quality for CTSDs with time-based surveillance indicators. %M 40132185 %R 10.2196/54651 %U https://www.i-jmr.org/2025/1/e54651 %U https://doi.org/10.2196/54651 %U http://www.ncbi.nlm.nih.gov/pubmed/40132185 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e63338 %T Measuring Adult Health and Well-Being Outcomes Associated With Nature Contact in Parks and Other Forms of Protected Areas: Protocol for a Scoping Review %A Bueddefeld,Jill %A Reining,Catherine E %A Lavallee,Loraine %A Brady,Ryan %A Groulx,Mark W %A Lemieux,Christopher James %+ Geography and Environmental Studies, Wilfrid Laurier University, 75 University Ave. West, Waterloo, ON, N2L 3C5, Canada, 1 5194968554, clemieux@wlu.ca %K nature contact %K human health %K mental health %K well-being %K parks %K protected areas %K outcomes %D 2025 %7 24.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Growing evidence shows various health and well-being benefits from nature contact in parks and other forms of protected areas. However, the methods to measure these outcomes lack systematic identification, critical appraisal, and synthesis. Researchers working in this area would benefit from a clear framework highlighting key considerations when selecting measurement tools, along with a summary of the measures used, and insights into the limitations of generalizing existing research findings. Objective: The objectives of this scoping review are 2-fold. First, we aim to identify the instruments used to measure mental health and well-being outcomes of adults associated with direct nature contact in parks and other forms of protected areas. Second, we aim to evaluate the psychometric properties associated with the validity of these instruments to better understand the strengths and weaknesses of current measurement approaches. Methods: Following PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, 8 scholarly databases were searched (PubMed, Web of Science, PsycINFO [via ProQuest], ERIC [via EBSCOhost], CINAHL [via EBSCOhost], GreenFILE [via EBSCOhost], OVID, and GEOBASE) on January 4, 2023, for literature measuring the mental health and well-being outcomes associated with nature contact in protected areas. Sources were screened by reviewers based on clear inclusion or exclusion criteria relevant to the research questions: peer-reviewed English language studies measuring mental health and well-being focused on adults (aged 18+ years) with direct, in-person nature contact in parks and protected areas. Data will be extracted, analyzed, and represented according to 3 domains. This includes study details, characteristics of the measurement instruments, and their validity. Results: The results of the study and submission of a manuscript for peer review are expected in April 2025. The results of the scoping review are expected to contribute to an understanding of the diverse methods used to measure mental health and well-being related to nature contact in protected areas. Expected findings will include an organized summary of existing quantitative and qualitative instruments for measuring mental health and well-being outcomes, including appraisal of the instrument’s psychometric properties. Conclusions: To the authors’ knowledge, this will be the first scoping review undertaken on measures used to assess mental health and well-being outcomes related to nature contact in parks and protected areas context, offering a starting point from which to critically examine the validity and consistency of such methods. Findings will aid in identifying the strengths and weaknesses of current measurement approaches to mental health and well-being outcomes of nature contact and may be used to guide future research on this topic, helping researchers choose the best tool to assess outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/63338 %M 40126537 %R 10.2196/63338 %U https://www.researchprotocols.org/2025/1/e63338 %U https://doi.org/10.2196/63338 %U http://www.ncbi.nlm.nih.gov/pubmed/40126537 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66683 %T Associations Among Online Health Information Seeking Behavior, Online Health Information Perception, and Health Service Utilization: Cross-Sectional Study %A Li,Hongmin %A Li,Dongxu %A Zhai,Min %A Lin,Li %A Cao,ZhiHeng %+ School of Public Health, Jining Medical University, No 133 Hehua Road, Taibaihu District, Shandong, Jining, 272067, China, 86 05373616333, lidongxu0602@126.com %K online health information seeking (OHIS) %K online health information perception (OHIP) %K mediating effect %K health service utilization %K health information %K health perception %K data %K China %K Chinese General Social Survey (CGSS) %K database %K medical information %K survey %D 2025 %7 14.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Seeking online health information can empower individuals to better understand their health concerns, facilitating their ability to manage their health conditions more effectively. It has the potential to change the likelihood and frequency of health service usage. Although existing literature has demonstrated the prevalence of seeking online health information among different populations, the factors affecting online health information perception and discussions on the associations between seeking online health information and health service utilization are limited. Objective: We analyzed the associations between online health information seeking behavior and health service utilization, as well as the online health information perception delivery mechanism. Methods: We analyzed data from the Chinese General Social Survey, the first national representative survey conducted in mainland China. The independent variable was the online health information seeking behavior. The outcome variable was health service utilization by the respondents, and online health information perception was selected as the mediating variable in this analysis. Factor analysis was conducted to obtain online health information perception. Multiple regressions were performed to investigate the effect of online health information seeking behavior on physician visits. Bootstrap methods were conducted to test the mediation effects of online health information perception. Results: This analysis included 1475 cases. Among the participants, 939 (63.66%) sought online health information in the last 12 months. The mean age of the respondents was 46.72 (SD 15.86) years, and 794 (53.83%) were females. After controlling for other variables, individuals with online health information seeking behaviors showed 0.289 times more outpatient visits (P=.003), 0.131 times more traditional Chinese medicine outpatient visits (P=.01), and 0.158 times more Western medicine outpatient visits (P=.007) over the past year compared to those who did not seek health information online. Additionally, multiple regression analyses revealed statistically significant effects of gender, age, and health status on physician visits. The total effect revealed that seeking online health information significantly influenced the total physician visits (β=0.290; P=.003), indicating a certain correlation between online health information seeking behavior and physician visits. Seeking online health information had a significant positive impact on the perception (β=0.265; P<.001). The mediation effects analysis identified that online health information perception led to a significant increase in physician visits with the increase in the online health information seeking behaviors (β=0.232; P=.02). Conclusions: The online health information perception of an individual influences the effect online health information seeking has on the frequency of physician visits. The online health information seeking behavior impacts outpatient service utilization both directly and indirectly through online health information perception and significantly increases the frequency of clinic visits after controlling for other variables. Interventions can be explored to improve the health utilization of residents by increasing their online health information perception. %M 40085841 %R 10.2196/66683 %U https://www.jmir.org/2025/1/e66683 %U https://doi.org/10.2196/66683 %U http://www.ncbi.nlm.nih.gov/pubmed/40085841 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e49464 %T Understanding Loneliness Through Analysis of Twitter and Reddit Data: Comparative Study %A Shah,Hurmat Ali %A Househ,Mowafa %+ Hamad Bin Khalifa University, Education City, Doha, Qatar, 974 70620740 ext 00, hshah@hbku.edu.qa %K health informatics %K loneliness informatics %K loneliness theory %K health effects %K loneliness interventions %K social media %K lonely %K loneliness %K isolation %K mental health %K natural language processing %K tweet %K tweets %K comparative analysis %D 2025 %7 14.3.2025 %9 Original Paper %J Interact J Med Res %G English %X Background: Loneliness is a global public health issue contributing to a variety of mental and physical health issues. It increases the risk of life-threatening conditions and contributes to the burden on the economy in terms of the number of productive days lost. Loneliness is a highly varied concept, which is associated with multiple factors. Objective: This study aimed to understand loneliness through a comparative analysis of loneliness data on Twitter and Reddit, which are popular social media platforms. These platforms differ in terms of their use, as Twitter allows only short posts, while Reddit allows long posts in a forum setting. Methods: We collected global data on loneliness in October 2022. Twitter posts containing the words “lonely,” “loneliness,” “alone,” “solitude,” and “isolation” were collected. Reddit posts were extracted in March 2023. Using natural language processing techniques (valence aware dictionary for sentiment reasoning [VADER] tool from the natural language toolkit [NLTK]), the study identified and extracted relevant keywords and phrases related to loneliness from user-generated content on both platforms. The study used both sentiment analysis and the number of occurrences of a topic. Quantitative analysis was performed to determine the number of occurrences of a topic in tweets and posts, and overall meaningful topics were reported under a category. Results: The extracted data were subjected to comparative analysis to identify common themes and trends related to loneliness across Twitter and Reddit. A total of 100,000 collected tweets and 10,000 unique Reddit posts, including comments, were analyzed. The results of the study revealed the relationships of various social, political, and personal-emotional themes with the expression of loneliness on social media. Both platforms showed similar patterns in terms of themes and categories of discussion in conjunction with loneliness-related content. Both Reddit and Twitter addressed loneliness, but they differed in terms of focus. Reddit discussions were predominantly centered on personal-emotional themes, with a higher occurrence of these topics. Twitter, while still emphasizing personal-emotional themes, included a broader range of categories. Both platforms aligned with psychological linguistic features related to the self-expression of mental health issues. The key difference was in the range of topics, with Twitter having a wider variety of topics and Reddit having more focus on personal-emotional aspects. Conclusions: Reddit posts provide detailed insights into data about the expression of loneliness, although at the cost of the diversity of themes and categories, which can be inferred from the data. These insights can guide future research using social media data to understand loneliness. The findings provide the basis for further comparative investigation of the expression of loneliness on different social media platforms and online platforms. %M 40085832 %R 10.2196/49464 %U https://www.i-jmr.org/2025/1/e49464 %U https://doi.org/10.2196/49464 %U http://www.ncbi.nlm.nih.gov/pubmed/40085832 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e63291 %T Investigating the Association Between Mean Arterial Pressure on 28-Day Mortality Risk in Patients With Sepsis: Retrospective Cohort Study Based on the MIMIC-IV Database %A Chen,Qimin %A Li,Wei %A Wang,Ying %A Chen,Xianjun %A He,Dehua %A Liu,Ming %A Yuan,Jia %A Xiao,Chuan %A Li,Qing %A Chen,Lu %A Shen,Feng %K mean arterial pressure %K 28-day mortality %K sepsis %K MIMIC-Ⅳ %K retrospective study %K Medical Information Mart for Intensive Care IV %D 2025 %7 5.3.2025 %9 %J Interact J Med Res %G English %X Background: Sepsis is a globally recognized health issue that continues to contribute significantly to mortality and morbidity in intensive care units (ICUs). The association between mean arterial pressure (MAP) and prognosis among patients with patients is yet to be demonstrated. Objective: The aim of this study was to explore the association between MAP and 28-day mortality in ICU patients with sepsis using data from a large, multicenter database. Methods: This is a retrospective cohort study. We extracted data of 35,010 patients with sepsis from the MIMIC-IV (Medical Information Mart for Intensive Care) database between 2008 and 2019, according to the Sepsis 3.0 diagnostic criteria. The MAP was calculated as the average of the highest and lowest readings within the first 24 hours of ICU admission, and patients were divided into 4 groups based on the mean MAP, using the quadruple classification approach. Other worst-case indications from the first 24 hours of ICU admission, such as vital signs, severity of illness scores, laboratory indicators, and therapies, were also gathered as baseline data. The independent effects of MAP on 28-day mortality were explored using binary logistic regression and a two-piecewise linear model, with MAP as the exposure and 28-day mortality as the outcome variables, respectively. To address the nonlinearity relationship, curve fitting and a threshold effect analysis were performed. Results: A total of 34,981 patients with sepsis were included in the final analysis, the mean age was 66.67 (SD 16.01) years, and the 28-day mortality rate was 16.27% (5691/34,981). The generalized additive model and smoothed curve fitting found a U-shaped relationship between MAP and 28-day mortality in these patients. The recursive algorithm determined the low and high inflection points as 70 mm and 82 mm Hg, respectively. Our data demonstrated that MAP was negatively associated with 28-day mortality in the range of 34.05 mm Hg-69.34 mm Hg (odds ratio [OR] 0.93, 95% CI 0.92-0.94; P<.001); however, once the MAP exceeded 82 mm Hg, a positive association existed between MAP and 28-day mortality of patients with sepsis (OR 1.01; 95% CI 1.01-1.02, P=.002). Conclusions: There is a U-shaped association between MAP and the probability of 28-day mortality in patients with sepsis. Both the lower and higher MAP were related with a higher risk of mortality in patients with sepsis. These patients have a decreased risk of mortality when their MAP remains between 70 and 82 mm Hg. %R 10.2196/63291 %U https://www.i-jmr.org/2025/1/e63291 %U https://doi.org/10.2196/63291 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64667 %T The Impact of Stay-At-Home Mandates on Uncertainty and Sentiments: Quasi-Experimental Study %A Biliotti,Carolina %A Fraccaroli,Nicolò %A Puliga,Michelangelo %A Bargagli-Stoffi,Falco J %A Riccaboni,Massimo %+ W R Rhodes Center for International Economics and Finance, Brown University, 111 Thayer Street, Box 1970, Providence, RI, United States, 1 401 863 2809, nicolo_fraccaroli@brown.edu %K lockdown policy %K sentiment analysis %K uncertainty %K social media %K quasi-experiment %D 2025 %7 4.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: As the spread of the SARS-CoV-2 virus coincided with lockdown measures, it is challenging to distinguish public reactions to lockdowns from responses to COVID-19 itself. Beyond the direct impact on health, lockdowns may have worsened public sentiment toward politics and the economy or even heightened dissatisfaction with health care, imposing a significant cost on both the public and policy makers. Objective: This study aims to analyze the causal effect of COVID-19 lockdown policies on various dimensions of sentiment and uncertainty, using the Italian lockdown of February 2020 as a quasi-experiment. At the time of implementation, communities inside and just outside the lockdown area were equally exposed to COVID-19, enabling a quasi-random distribution of the lockdown. Additionally, both areas had similar socioeconomic and demographic characteristics before the lockdown, suggesting that the delineation of the strict lockdown zone approximates a randomized experiment. This approach allows us to isolate the causal effects of the lockdown on public emotions, distinguishing the impact of the policy itself from changes driven by the virus’s spread. Methods: We used Twitter data (N=24,261), natural language models, and a difference-in-differences approach to compare changes in sentiment and uncertainty inside (n=1567) and outside (n=22,694) the lockdown areas before and after the lockdown began. By fine-tuning the AlBERTo (Italian BERT optimized) pretrained model, we analyzed emotions expressed in tweets from 1124 unique users. Additionally, we applied dictionary-based methods to categorize tweets into 4 dimensions—economy, health, politics, and lockdown policy—to assess the corresponding emotional reactions. This approach enabled us to measure the direct impact of local policies on public sentiment using geo-referenced social media and can be easily adapted for other policy impact analyses. Results: Our analysis shows that the lockdown had no significant effect on economic uncertainty (b=0.005, SE 0.007, t125=0.70; P=.48) or negative economic sentiment (b=–0.011, SE 0.0089, t125=–1.32; P=.19). However, it increased uncertainty about health (b=0.036, SE 0.0065, t125=5.55; P<.001) and lockdown policy (b=0.026, SE 0.006, t125=4.47; P<.001), as well as negative sentiment toward politics (b=0.025, SE 0.011, t125=2.33; P=.02), indicating that lockdowns have broad externalities beyond health. Our key findings are confirmed through a series of robustness checks. Conclusions: Our findings reveal that lockdowns have broad externalities extending beyond health. By heightening health concerns and negative political sentiment, policy makers have struggled to secure explicit public support for government measures, which may discourage future leaders from implementing timely stay-at-home policies. These results highlight the need for authorities to leverage such insights to enhance future policies and communication strategies, reducing uncertainty and mitigating social panic. %M 40053818 %R 10.2196/64667 %U https://www.jmir.org/2025/1/e64667 %U https://doi.org/10.2196/64667 %U http://www.ncbi.nlm.nih.gov/pubmed/40053818 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e63987 %T Correlation Between Objective Habit Metrics and Objective Medication Adherence: Retrospective Study of 15,818 Participants From Clinical Studies %A Pironet,Antoine %A Phillips,L Alison %A Vrijens,Bernard %+ AARDEX Group, rue Bois St Jean 15/1, Seraing, 4102, Belgium, 32 43748640, antoine.pironet@aardexgroup.com %K medication adherence %K compliance %K habit %K history %K correlation %K association %K intake %K electronic database %K retrospective %K medication %K drug %K adherence %D 2025 %7 6.2.2025 %9 Original Paper %J Interact J Med Res %G English %X Background: Medication adherence, or how patients take their medication as prescribed, is suboptimal worldwide. Improving medication-taking habit might be an effective way to improve medication adherence. However, habit is difficult to quantify, and conventional habit metrics are self-reported, with recognized limitations. Recently, several objective habit metrics have been proposed, based on objective medication-taking data. Objective: We aim to explore the correlation between objective habit metrics and objective medication adherence on a large dataset. Methods: The Medication Event Monitoring System Adherence Knowledge Center, a database of anonymized electronic medication intake data from ambulant participants enrolled in past clinical studies, was used as the data source. Electronic medication intake data from participants following a once-daily regimen and monitored for 14 days or more were used. Further, two objective habit metrics were computed from each participant’s medication intake history: (1) SD of the hour of intake, representing daily variability in the timing of medication intakes, and (2) weekly cross-correlation, representing weekly consistency in the timing of medication intakes. The implementation component of medication adherence was quantified using (1) the proportion of doses taken and (2) the proportion of correct days. Results: A total of 15,818 participants met the criteria. These participants took part in 108 clinical studies mainly focused on treatments for hypertension (n=4737, 30%) and osteoporosis (n=3353, 21%). The SD of the hour of intake was significantly negatively correlated with the 2 objective adherence metrics: proportion of correct days (Spearman correlation coefficient, ρS=–0.62, P<.001) and proportion of doses taken (ρS=–0.09, P<.001). The weekly cross-correlation was significantly positively correlated with the 2 objective adherence metrics: proportion of correct days (ρS=0.55, P<.001) and proportion of doses taken (ρS=0.32, P<.001). A lower daily or weekly variability in the timing of medication intakes is thus associated with better medication adherence. However, no variability is not the norm, as only 3.6% of participants have 95% of their intakes in a 1-hour window. Among the numerous factors influencing medication adherence, habit strength is an important one as it explains over 30% of the variance in medication adherence. Conclusions: Objective habit metrics are correlated to objective medication adherence. Such objective habit metrics can be used to monitor patients and identify those who may benefit from habit-building support. %M 39914802 %R 10.2196/63987 %U https://www.i-jmr.org/2025/1/e63987 %U https://doi.org/10.2196/63987 %U http://www.ncbi.nlm.nih.gov/pubmed/39914802 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 6 %N %P e50458 %T Converting Organic Municipal Solid Waste Into Volatile Fatty Acids and Biogas: Experimental Pilot and Batch Studies With Statistical Analysis %A Borhany,Hojjat %K multistep fermentation %K specific methane production %K anaerobic digestion %K kinetics study %K biochar %K first-order %K modified Gompertz %K mass balance %K waste management %K environment sustainability %D 2025 %7 4.2.2025 %9 %J JMIRx Med %G English %X Background: Italy can augment its profit from biorefinery products by altering the operation of digesters or different designs to obtain more precious bioproducts like volatile fatty acids (VFAs) than biogas from organic municipal solid waste. In this context, recognizing the process stability and outputs through operational interventions and its technical and economic feasibility is a critical issue. Hence, this study involves an anaerobic digester in Treviso in northern Italy. Objective: This research compares a novel line, consisting of pretreatment, acidogenic fermentation, and anaerobic digestion, with single-step anaerobic digestion regarding financial profit and surplus energy. Therefore, a mass flow model was created and refined based on the outputs from the experimental and numerical studies. These studies examine the influence of hydraulic retention time (HRT), pretreatment, biochar addition, and fine-tuned feedstock/inoculum (FS/IN) ratio on bioproducts and operational parameters. Methods: VFA concentration, VFA weight ratio distribution, and biogas yield were quantified by gas chromatography. A t test was then conducted to analyze the significance of dissimilar HRTs in changing the VFA content. Further, a feasible biochar dosage was identified for an assumed FS/IN ratio with an adequately long HRT using the first-order rate model. Accordingly, the parameters for a mass flow model were adopted for 70,000 population equivalents to determine the payback period and surplus energy for two scenarios. We also explored the effectiveness of amendments in improving the process kinetics. Results: Both HRTs were identical concerning the ratio of VFA/soluble chemical oxygen demand (0.88 kg/kg) and VFA weight ratio distribution: mainly, acetic acid (40%), butyric acid (24%), and caproic acid (17%). However, a significantly higher mean VFA content was confirmed for an HRT of 4.5 days than the quantity for an HRT of 3 days (30.77, SD 2.82 vs 27.66, SD 2.45 g–soluble chemical oxygen demand/L), using a t test (t8=−2.68; P=.03; CI=95%). In this research, 83% of the fermented volatile solids were converted into biogas to obtain a specific methane (CH4) production of 0.133 CH4-Nm3/kg–volatile solids. While biochar addition improved only the maximum methane content by 20% (86% volumetric basis [v/v]), the FS/IN ratio of 0.3 volatile solid basis with thermal plus fermentative pretreatment improved the hydrolysis rate substantially (0.57 vs 0.07, 1/d). Furthermore, the biochar dosage of 0.12 g-biochar/g–volatile solids with an HRT of 20 days was identified as a feasible solution. Principally, the payback period for our novel line would be almost 2 years with surplus energy of 2251 megajoules [MJ] per day compared to 45 years and 21,567 MJ per day for single-step anaerobic digestion. Conclusions: This research elaborates on the advantage of the refined novel line over the single-step anaerobic digestion and confirms its financial and technical feasibility. Further, changing the HRT and other amendments significantly raised the VFA concentration and the process kinetics and stability. %R 10.2196/50458 %U https://xmed.jmir.org/2025/1/e50458 %U https://doi.org/10.2196/50458 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63634 %T Health and Experiences During the COVID-19 Pandemic Among Children and Young People: Analysis of Free-Text Responses From the Children and Young People With Long COVID Study %A Rojas,Natalia K %A Martin,Sam %A Cortina-Borja,Mario %A Shafran,Roz %A Fox-Smith,Lana %A Stephenson,Terence %A Ching,Brian C F %A d'Oelsnitz,Anaïs %A Norris,Tom %A Xu,Yue %A McOwat,Kelsey %A Dalrymple,Emma %A Heyman,Isobel %A Ford,Tamsin %A Chalder,Trudie %A Simmons,Ruth %A , %A Pinto Pereira,Snehal M %+ Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, 43-45 Foley St, W1W 7TY, London, United Kingdom, 44 (0) 20 7679 200, n.rojas@ucl.ac.uk %K children and young people %K text mining %K free-text responses %K experiences %K COVID-19 %K long COVID %K InfraNodus %K sentiment analysis %K discourse analysis %K AI %K artificial intelligence %D 2025 %7 28.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The literature is equivocal as to whether the predicted negative mental health impact of the COVID-19 pandemic came to fruition. Some quantitative studies report increased emotional problems and depression; others report improved mental health and well-being. Qualitative explorations reveal heterogeneity, with themes ranging from feelings of loss to growth and development. Objective: This study aims to analyze free-text responses from children and young people participating in the Children and Young People With Long COVID study to get a clearer understanding of how young people were feeling during the pandemic. Methods: A total of 8224 free-text responses from children and young people were analyzed using InfraNodus, an artificial intelligence–powered text network analysis tool, to determine the most prevalent topics. A random subsample of 411 (5%) of the 8224 responses underwent a manual sentiment analysis; this was reweighted to represent the general population of children and young people in England. Results: Experiences fell into 6 main overlapping topical clusters: school, examination stress, mental health, emotional impact of the pandemic, social and family support, and physical health (including COVID-19 symptoms). Sentiment analysis showed that statements were largely negative (314/411, 76.4%), with a small proportion being positive (57/411, 13.9%). Those reporting negative sentiment were mostly female (227/314, 72.3%), while those reporting positive sentiment were mostly older (170/314, 54.1%). There were significant observed associations between sentiment and COVID-19 status as well as sex (P=.001 and P<.001, respectively) such that the majority of the responses, regardless of COVID-19 status or sex, were negative; for example, 84.1% (227/270) of the responses from female individuals and 61.7% (87/141) of those from male individuals were negative. There were no observed associations between sentiment and all other examined demographics. The results were broadly similar when reweighted to the general population of children and young people in England: 78.52% (negative), 13.23% (positive), and 8.24% (neutral). Conclusions: We used InfraNodus to analyze free-text responses from a large sample of children and young people. The majority of responses (314/411, 76.4%) were negative, and many of the children and young people reported experiencing distress across a range of domains related to school, social situations, and mental health. Our findings add to the literature, highlighting the importance of specific considerations for children and young people when responding to national emergencies. %M 39874576 %R 10.2196/63634 %U https://www.jmir.org/2025/1/e63634 %U https://doi.org/10.2196/63634 %U http://www.ncbi.nlm.nih.gov/pubmed/39874576 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63217 %T Resilience Informatics in Public Health: Qualitative Analysis of Conference Proceedings %A Block Ngaybe,Maiya G %A Azurdia Sierra,Lidia %A McNair,Andrew %A Gonzalez,Myla %A Arora,Mona %A Ernst,Kacey %A Noriega-Atala,Enrique %A Iyengar,M Sriram %+ College of Medicine - Phoenix, University of Arizona, 475 N 5th St, Phoenix, AZ, 85004, United States, 1 281 793 4733, msiyengar@arizona.edu %K resilience %K public health %K informatics %K mobile phone %K artificial intelligence %K AI %D 2025 %7 16.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: In recent years, public health has confronted 2 formidable challenges: the devastating COVID-19 pandemic and the enduring threat of climate change. The convergence of these crises underscores the urgent need for resilient solutions. Resilience informatics (RI), an emerging discipline at the intersection of informatics and public health, leverages real-time data integration from health systems, environmental monitoring, and technological tools to develop adaptive responses to multifaceted crises. It offers promising avenues for mitigating and adapting to these challenges by proactively identifying vulnerabilities and fostering adaptive capacity in public health systems. Addressing critical questions regarding target audiences, privacy concerns, and scalability is paramount to fostering resilience in the face of evolving health threats. Objective: The University of Arizona held a workshop, titled Resilience Informatics in Public Health, in November 2023 to serve as a pivotal forum for advancing these discussions and catalyzing collaborative efforts within the field. This paper aims to present a qualitative thematic analysis of the findings from this workshop. Methods: A purposive sampling strategy was used to invite 40 experts by email from diverse fields, including public health, medicine, weather services, informatics, environmental science, and resilience, to participate in the workshop. The event featured presentations from key experts, followed by group discussions facilitated by experts. The attendees engaged in collaborative reflection and discussion on predetermined questions. Discussions were systematically recorded by University of Arizona students, and qualitative analysis was conducted. A detailed thematic analysis was performed using an inductive approach, supported by MAXQDA software to manage and organize data. Two independent researchers coded the transcripts; discrepancies in coding were resolved through consensus, ensuring a rigorous synthesis of the findings. Results: The workshop hosted 27 experts at the University of Arizona, 21 (78%) of whom were from public health–related fields. Of these 27 experts, 8 (30%) were from the field of resilience. In addition, participants from governmental agencies, American Indian groups, weather services, and a mobile health organization attended. Qualitative analysis identified major themes, including the potential of RI tools, threats to resilience (eg, health care access, infrastructure, and climate change), challenges with RI tools (eg, usability, funding, and real-time response), and standards for RI tools (eg, technological, logistical, and sociological). The attendees emphasized the importance of equitable access, community engagement, and iterative development in RI projects. Conclusions: The RI workshop emphasized the necessity for accessible, user-friendly tools bridging technical knowledge and community needs. The workshop’s conclusions provide a road map for future public health resilience, highlighting the need for scalable, culturally sensitive, community-driven interventions. Future directions include focused discussions to yield concrete outputs such as implementation guidelines and tool designs, reshaping public health strategies in the face of emerging threats. %M 39819984 %R 10.2196/63217 %U https://formative.jmir.org/2025/1/e63217 %U https://doi.org/10.2196/63217 %U http://www.ncbi.nlm.nih.gov/pubmed/39819984 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e50058 %T Contribution of Travelers to Plasmodium Vivax Malaria in South West Delhi, India: Cross-Sectional Survey %A Savargaonkar,Deepali %A Srivastava,Bina %A Yadav,Chander Prakash %A Singh,Mrigendra Pal %A Anvikar,Anup %A Sharma,Amit %A Singh,Himmat %A Sinha,Abhinav %K malaria %K Plasmodium vivax %K imported malaria %K population movement %K transmission %K elimination %K India %D 2025 %7 8.1.2025 %9 %J JMIR Public Health Surveill %G English %X Background: India is committed to malaria elimination by the year 2030. According to the classification of malaria endemicity, the National Capital Territory of Delhi falls under category 1, with an annual parasite incidence of <1, and was targeted for elimination by 2022. Among others, population movement across states is one of the key challenges for malaria control, as it can result in imported malaria, thus introducing local transmission in an area nearing elimination. Objective: This descriptive study attempts to assess the contribution of such imported Plasmodium vivax cases to the malaria burden in South West Delhi (SWD). Methods: A cross-sectional study was carried out at the fever clinic of the Indian Council of Medical Research-National Institute of Malaria Research in SWD from January 2017 to December 2019. Demographic and travel history data were recorded for all P vivax confirmed malaria cases diagnosed at the fever clinic. Vector and fever surveys along with reactive case detection were conducted in SWD and Bulandshahr district of Uttar Pradesh, 1 of the 6 geographical sources for a high number of imported malaria cases. Results: A total of 355 P vivax malaria cases were reported during the study period. The proportion of imported cases was 63% (n=222). Of these, 96% (n=213) of cases were from Uttar Pradesh. The distribution of malaria cases revealed that imported cases were significantly associated with travel during the transmission season compared with that in the nontransmission season. Entomological and fever surveys and reactive case detection carried out in areas visited by imported P vivax malaria cases showed the presence of adults and larvae of Anopheles species and P vivax parasitemia. Conclusions: Population movement is a key challenge for malaria elimination. Although additional P vivax infections and vector mosquitoes were detected at places visited by the imported malaria cases, the inability to detect the parasite in mosquitoes and the possibility of relapses associated with P vivax limit the significance of malaria associated with the travel. However, there remains a need to address migration malaria to prevent the introduction and re-establishment of malaria in areas with very low or 0 indigenous cases. %R 10.2196/50058 %U https://publichealth.jmir.org/2025/1/e50058 %U https://doi.org/10.2196/50058 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e60622 %T Interstep Variations of Stairways and Associations of High-Contrast Striping and Fall-Related Events: Observational Study %A Harper,Sara A %A Brown,Chayston %A Poulsen,Shandon L %A Barrett,Tyson S %A Dakin,Christopher J %+ Kinesiology Department, University of Alabama in Huntsville, 301 Sparkman Drive NW, Huntsville, AL, 35899, United States, 1 256 824 2184, sah0075@uah.edu %K stairs %K stairway safety %K riser height %K tread depth %K horizontal-vertical illusion %K fall risk %K fall prevention %K videos %K Monte Carlo simulation %K public health %K vision-based strategy %K health promotion %K adults %K geriatric %D 2025 %7 8.1.2025 %9 Original Paper %J Interact J Med Res %G English %X Background: Interstep variations in step riser height and tread depth within a stairway could negatively impact safe stair negotiation by decreasing step riser height predictability and, consequently, increasing stair users’ fall risk. Unfortunately, interstep variations in riser height and depth are common, particularly in older stairways, but its impact may be lessened by highlighting steps’ edges using a high-contrast stripe on the top front edge of each step. Objective: This study aimed to determine (1) if fall-related events are associated with greater interstep riser height and depth variations and (2) if such fall-related events are reduced in the presence of contrast-enhanced step edges compared with a control stairway. Methods: Stair users were video recorded on 2 public stairways in a university building. One stairway had black vinyl stripes applied to the step’s edges and black-and-white vertical stripes on the last and top steps’ faces. The stairway with striping was counterbalanced, with the striped stairway than a control, and the control with stripes. Each stair user recorded was coded for whether they experienced a fall-related event. A total of 10,000 samples (observations) of 20 fall-related events were drawn with 0.25 probability from each condition to determine the probability of observing a distribution with the constraints outlined by the hypotheses by a computerized Monte Carlo simulation. Results: In total, 11,137 individual stair user observations had 20 fall-related events. The flights that had 14 mm in interstep riser height variation and 38 mm in interstep depth variation were associated with 80% (16/20) of the fall-related events observed. Furthermore, 2 fall-related events were observed for low interstep variation with no striping, and 2 fall-related events were observed during low interstep variation with striping. A total of 20 fall-related events were observed, with 4 occurring on flights of stairs with low interstep variation. For stairs with high variability in step dimensions, 13 of 16 (81%) fall-related events occurred on the control stairway (no striping) compared with 3 of 16 (19%) on the high-contrast striping stairway. The distribution of fall-related events we observed between conditions likely did not occur by chance, with a probability of 0.04. Conclusions: These data support the premise that a vision-based strategy (ie, striping) may counteract fall risk associated with interstep riser height and tread depth variation. Possibly, perception and action elicited through the horizontal-vertical illusion (striping) may have a positive impact on the incidence of fall-related events in the presence of high interstep riser height and depth variation. The findings of this study suggest that contrast enhancement (ie, striping) may be a simple and effective way to reduce the risk of falls associated with interstep variation, highlighting the potential for this approach to make a significant impact on fall prevention efforts. %M 39773894 %R 10.2196/60622 %U https://www.i-jmr.org/2025/1/e60622 %U https://doi.org/10.2196/60622 %U http://www.ncbi.nlm.nih.gov/pubmed/39773894 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e59562 %T Simplified Medication Adherence Questionnaire (SMAQ) for People Living With HIV in a National Hospital in Mexico: Instrument Validation Study %A Del Moral Trinidad,Luis Eduardo %A González Hernández,Luz Alicia %A Andrade Villanueva,Jaime Federico %A Martínez-Ayala,Pedro %A Valle Rodríguez,Adriana %A Ruíz Herrera,Vida Veronica %A Vizcaíno Résendiz,José Adán %A Herrera Godina,Melva Guadalupe %A Dominguez-Lara,Sergio %+ Research Institute, Facultad de Ciencias de la Comunicación, Turismo y Psicología, University of San Martín de Porres, Avenue Tomás Marsano 242 (5th floor), Lima, 15048, Peru, 51 5136300, sdominguezmpcs@gmail.com %K treatment adherence %K HIV %K Mexico %K validation %K Spanish %K Hispanic %K cross sectional %K surveys %K questionnaires %K scales %K adherence %K viral load %K sexually transmitted infection %K STI %K drugs %K pharmacotherapy %K medication %K simplified medication adherence questionnaire %K SMAQ %D 2025 %7 7.1.2025 %9 Original Paper %J Interact J Med Res %G English %X Background: Adherence to antiretroviral therapy is a critical component in achieving viral suppression in people living with HIV in addition to increasing overall quality of life. Several indirect methods have been used to measure adherence including the Simplified Medication Adherence Questionnaire (SMAQ). Objective: The objective of this study is to evaluate the reliability and validity of the SMAQ in men living with HIV/AIDS attending a Mexican national hospital. Methods: A cross-sectional analytical design study was carried out in a Mexican National Hospital in Jalisco, including men aged >18 years with at least 3 months of antiretroviral treatment, excluding those with cognitive difficulties in answering the survey. A minimum sample size was calculated to detect the contribution of the variables within the model. The analysis included descriptive tests, confirmatory factor analysis, reliability and validity assessment, correlation between adherence and viral load, and association between viral load and adherence. Results: The final analysis included a total of 260 patients with a mean age of 43 (SD 12) years and an average of 8.97 (SD 6.33) years on antiretroviral treatment. The SMAQ showed sufficient structural validity (comparative fit index=1, root-mean-square error of approximation=0, 90% CI 0-0.085) with satisfactory factor loadings on most questions except item 2 (Do you always take your medication at the prescribed time?). The reliability of the scale is acceptable (Cronbach α=0.702, ω=0.718). Adherence correlated with viral load significantly but not with recent TCD4 lymphocyte levels. Patients classified as adherent were three times more likely to be undetectable than nonadherent patients (odds ratio 3.31, 95% CI 1.13-9.64, P=.04). Conclusions: The SMAQ represents an adequate tool to assess adherence in men living with HIV in the Mexican context, this will contribute to this study and compression of adherence to establish future intervention programs. %M 39773472 %R 10.2196/59562 %U https://www.i-jmr.org/2025/1/e59562 %U https://doi.org/10.2196/59562 %U http://www.ncbi.nlm.nih.gov/pubmed/39773472 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e54240 %T Close-Up on Ambulance Service Estimation in Indonesia: Monte Carlo Simulation Study %A Brice,Syaribah N %A Boutilier,Justin J %A Palmer,Geraint %A Harper,Paul R %A Knight,Vincent %A Tuson,Mark %A Gartner,Daniel %+ School of Mathematics, Cardiff University, Senghennydd Road, Cardiff, CF24 4AG, United Kingdom, 44 (0)29 2087 4811, BriceSN@cardiff.ac.uk %K emergency medical services %K ambulance services %K hospital emergency services %K Southeast Asian countries %K low-and-middle-income countries %K EMS %K survey %D 2024 %7 13.12.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Emergency medical services have a pivotal role in giving timely and appropriate responses to emergency events caused by medical, natural, or human-caused disasters. To provide adequate resources for the emergency services, such as ambulances, it is necessary to understand the demand for such services. In Indonesia, estimates of demand for emergency services cannot be obtained easily due to a lack of published literature or official reports concerning the matter. Objective: This study aimed to ascertain an estimate of the annual volume of hospital emergency visits and the corresponding demand for ambulance services in the city of Jakarta. Methods: In this study, we addressed the problem of emergency services demand estimation when aggregated detailed data are not available or are not part of the routine data collection. We used survey data together with the local Office of National Statistics reports and sample data from hospital emergency departments to establish parameter estimation. This involved estimating 4 parameters: the population of each area per period (day and night), the annual per capita hospital emergency visits, the probability of an emergency taking place in each period, and the rate of ambulance need per area. Monte Carlo simulation and naïve methods were used to generate an estimation for the mean ambulance needs per area in Jakarta. Results: The results estimated that the total annual ambulance need in Jakarta is between 83,000 and 241,000. Assuming the rate of ambulance usage in Jakarta at 9.3%, we estimated the total annual hospital emergency visits in Jakarta at around 0.9-2.6 million. The study also found that the estimation from using the simulation method was smaller than the average (naïve) methods (P<.001). Conclusions: The results provide an estimation of the annual emergency services needed for the city of Jakarta. In the absence of aggregated routinely collected data on emergency medical service usage in Jakarta, our results provide insights into whether the current emergency services, such as ambulances, have been adequately provided. %M 39671572 %R 10.2196/54240 %U https://www.i-jmr.org/2024/1/e54240 %U https://doi.org/10.2196/54240 %U http://www.ncbi.nlm.nih.gov/pubmed/39671572 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60869 %T Evaluating the Impact of Assistive Technologies on Individuals With Disabilities in Benin: Protocol for a Cross-Sectional Study %A Atigossou,Orthelo Léonel Gbètoho %A Capo-chichi,Sègbédji Joseph Martial %A Mitchaї,Penielle Mahutchegnon %A Honado,Aristide S %+ Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale Nationale, 2975 Chemin Saint-Louis, Quebec, QC, QC G1W 1P9, Canada, 1 4185299141, orthelo-leonel-gbetoho.atigossou.1@ulaval.ca %K assistive technologies %K assistive technology assessment %K individuals with disabilities %K disabilities %K cross-sectional study %K well-being %K quality of life %K effects %K Benin %D 2024 %7 9.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: A significant proportion of individuals with disabilities in resource-limited countries require at least 1 assistive technology (AT) device to enhance their functioning and autonomy. However, there is limited evidence regarding the actual needs of AT users in these regions concerning the adequacy of ATs. Objective: This research aims to assess the effects of ATs on AT users in a resource-limited country. Methods: A cross-sectional study will be conducted in Benin, a sub-Saharan African country, using a nonprobability sample of AT users. Participants will undergo evaluation using standardized tools to assess their psycho-affective status, satisfaction with ATs, perception of the functional effects of ATs, well-being, and quality of life. Additionally, a survey based on the World Health Organization's rATA (rapid assistive technology assessment) tool will be conducted to gather sociodemographic and other data concerning the use of ATs. The findings will be organized and discussed using the Consortium on Assistive Technology Outcomes Research taxonomy, focusing on aspects related to the effectiveness and social significance of ATs, as well as the subjective well-being of AT users. Results: The process of identifying potential participants began in August 2024, and data collection is scheduled to start in January 2025 and continue for 12 months. Conclusions: This research will provide an overview of the effects induced by the use of ATs, as well as describe the profile of AT users in Benin. To our knowledge, this will be the first study to examine the impact of ATs in Benin. It will therefore make a significant contribution to the existing data on the use of ATs in sub-Saharan Africa. International Registered Report Identifier (IRRID): PRR1-10.2196/60869 %M 39652842 %R 10.2196/60869 %U https://www.researchprotocols.org/2024/1/e60869 %U https://doi.org/10.2196/60869 %U http://www.ncbi.nlm.nih.gov/pubmed/39652842 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60963 %T Global and Regional Prevalence of Domestic Violence During the COVID-19 Pandemic and Its Determinants: Protocol for a Systematic Review and Meta-Analysis %A Bidhendi-Yarandi,Razieh %A Biglarian,Akbar %A Nosrati Nejad,Farhad %A Roshanfekr,Payam %A Behboudi-Gandevani,Samira %+ Faculty of Nursing and Health Sciences, Nord University, Postbox 1490, Bodø, 8049, Norway, 47 75517670, samira.behboudi-gandevani@nord.no %K COVID-19 %K domestic violence %K systematic review and meta-analysis %K lockdowns %K pandemic effects %K intimate partner violence %K elder abuse %K child abuse %K vulnerable populations %D 2024 %7 9.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Domestic violence is one of the most significant global public health priorities. This social problem could be accelerated by global catastrophes such as the COVID-19 pandemic. The structural changes due to the imposition of health measures, combined with personal and social problems, may worsen the situation. Objective: This study aims to investigate the global and regional prevalence of domestic violence during the COVID-19 pandemic and its determinants. Methods: We will perform a comprehensive review of the literature in PubMed, PsycINFO, Embase, Cochrane COVID-19 Register, and Applied Social Sciences Index and Abstracts, up to July 2024. This review will adhere to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. Observational studies will be considered eligible if they have a population-based design, report the number of cases or prevalence of domestic violence during the COVID-19 pandemic, and report potential determinants. Studies in languages other than English, those with unclear data, case reports, conference proceedings, reviews, and letters will be excluded. To assess the methodological quality, a standardized critical appraisal checklist for studies reporting prevalence data will be used. A robust Bayesian approach will be applied using the STATA software package (version 14; STATA Inc) and JASP 0.19.1 (GNU Affero General Public License [GNU AGPL]) software. Results: The search and screening for the systematic literature review are anticipated to be finished in October 2024. Data extraction, quality appraisal, and subsequent data synthesis will begin in November 2024. The review is expected to be completed by April 2025, and the study results will be published in 2025. Conclusions: This systematic review and meta-analysis will address significant gaps in understanding the pandemic’s impact on domestic violence, providing a comprehensive assessment of its prevalence and contributing factors. Despite some limitations, the study incorporates diverse data sources and vulnerable groups to offer a detailed and accurate picture. The findings will inform targeted interventions and policy responses to mitigate the impact of future global crises on domestic violence rates. Trial Registration: PROSPERO CRD42022351634; https://tinyurl.com/yth37jkx International Registered Report Identifier (IRRID): PRR1-10.2196/60963 %M 39652848 %R 10.2196/60963 %U https://www.researchprotocols.org/2024/1/e60963 %U https://doi.org/10.2196/60963 %U http://www.ncbi.nlm.nih.gov/pubmed/39652848 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e60949 %T Development and Evaluation of 4 Short, Animated Videos for Women in Midlife Promoting Positive Health Behaviors: Survey Study %A Hammarberg,Karin %A Bandyopadhyay,Mridula %A Nguyen,Hau %A Cicuttini,Flavia %A Stanzel,Karin Andrea %A Brown,Helen %A Hickey,Martha %A Fisher,Jane %+ School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Rd, Melbourne, 3004, Australia, 61 418306023, karin.hammarberg@monash.edu %K health promotion %K healthy aging %K self-management %K midlife %K menopause %K internet %K video %K animation %K survey %K questionnaire %K education %K women %K gynecology %D 2024 %7 2.12.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Health and health behaviors in midlife are important determinants of healthy aging. There is evidence of unmet needs for health-promoting information for women from culturally and linguistically diverse backgrounds and women with low literacy. Objective: This study aimed to (1) develop accessible short, animated videos viewable and downloadable from YouTube aimed at promoting positive health behaviors in women in midlife and (2) evaluate their accessibility, acceptability, understanding, and usability and whether this was influenced by the level of education or socioeconomic disadvantage. Methods: In collaboration with a video production company, a multidisciplinary team of academics and health professionals developed 2 short, animated videos on self-management of menopause health and 2 promoting joint health. Their accessibility, acceptability, understanding, and usability to women were evaluated in an anonymous web-based survey. Results: A total of 490 women viewed the videos and responded to the survey. Of these, 353 (72%) completed all questions. Almost all (from 321/353, 91% to 334/363, 92%) agreed that the information in the videos was “very easy to understand.” The proportions reporting that all or some of the information in the video was new to them varied between videos from 36% (137/386) to 66% (233/353), the reported likelihood of using the practical tips offered in the videos varied from 70% (271/386) to 89% (331/373), and between 61% (235/386) and 70% (263/373) of respondents stated that they would recommend the videos to others. Education-level group comparisons revealed few differences in opinions about the videos, except that women with lower education were more likely than those with higher education to state that they would recommend the 2 joint health videos to others (36/45, 80% vs 208/318, 65%; P=.051 for video 3; and 36/44, 80% vs 197/309, 64%; P=.04 for video 4). There were no differences between women living in the least advantaged areas (Socioeconomic Indexes for Areas quintile areas 1 and 2) and those living in the most advantaged areas (Socioeconomic Indexes for Areas quintile areas 3, 4, and 5) in their responses to any of the questions about the 4 videos. Conclusions: Most women found the videos easy to understand, learned something new from watching them, planned to use the practical tips they offered, and were likely to recommend them to other women. This suggests that short, animated videos about health self-management strategies in midlife to improve the chance of healthy aging are perceived as accessible, acceptable, easy to understand, and useful by women. %M 39621404 %R 10.2196/60949 %U https://www.i-jmr.org/2024/1/e60949 %U https://doi.org/10.2196/60949 %U http://www.ncbi.nlm.nih.gov/pubmed/39621404 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60289 %T Understanding the Occurrence and Fate of Atmospheric Microplastics and Their Potential Risks to Human Health: Protocol for a Cross-Sectional Analysis %A Hasan,Shaikh Sharif %A Salam,Abdus %A Moniruzzaman,Mohammad %A Bari,Md Aynul %A Aich,Nirupam %A Jahan,Farjana %A Rahman,Mahbubur %A Islam,Zubayer %A Kabir,Md Humayun %A Shaikh,Md Aftab Ali %A Raqib,Rubhana %A Parvez,Sarker Masud %+ Children’s Health and Environment Program, Child Health Research Centre, The University of Queensland, St Lucia, Brisbane Queensland 4072, Brisbane, 4072, Australia, 61 480365175, s.parvez@uq.edu.au %K plastic exposure %K microplastic %K bisphenol %K phthalate %K heavy metals %K health consequences %K potential risk %K cross-sectional analysis %K pollution %K nanoplastics %K additives %K plastic additives %K health consequence %K exposure %K human exposure %K plastic recycling %K recycling activities %D 2024 %7 29.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Plastic pollution has reached an alarming magnitude, defining the contemporary era as the “Plastic Age.” Uncontrolled plastic production and inadequate recycling processes have led to widespread contamination of the environment with micro and nanoplastics. Objective: The study aims to assess the environmental and human health consequences of exposure to microplastic particles (MPs) and their additives among plastic recycling workers in Dhaka. Specifically, it focuses on mapping the management pathways of plastic waste from collection to disposal, analyzing the types of MPs in the environment, and assessing the potential health impacts on plastic recycling workers. Methods: A cross-sectional exploratory study design was used, consisting of exposed and nonexposed groups in plastic recycling sites in Dhaka, Bangladesh. The study will establish possible associations between different health consequences and microplastic particle exposure with a systematic approach involving plastic recycling hot spot detection, management pathway mapping, and detecting the presence of environmental MP. MPs and heavy metals will be detected from environmental samples using fluorescence microscopy, Fourier-transform infrared spectroscopy, and inductively coupled plasma mass spectrometry. Human exposure will be assessed by detecting the metabolites of bisphenol and phthalates from urine samples using liquid chromatography–tandem mass spectrometry and thoroughly evaluating endocrine, reproductive, respiratory, and renal functions. The sample size was derived from the mean concentrations of urinary bisphenol and phthalates metabolites, requiring the participation of 168 respondents. A 1:1 exposure to nonexposed stratification would be sufficient to meet our study objectives, considering the conventional level of power and confidence interval. This study protocol (PR#22111) has received approval from the Research Review Committee and Ethical Review Committee of the icddr,b. Results: The project was funded in August 2022. We started collecting environmental samples in January 2023 and completed participant enrollment, exposure survey, and biological sample collection by December 2023. We enrolled 84 adult plastic recycling workers with at least 5 years of exposure history and 84 nonexposed participants who were not involved with plastic recycling activities. Data analysis is currently underway, and the first results are expected to be submitted for publication in November 2024. Conclusions: The findings would provide valuable insights into the adverse impacts of microplastic pollution on both the environment and human health, aiding in better understanding the extent of the issue. International Registered Report Identifier (IRRID): DERR1-10.2196/60289 %M 39612491 %R 10.2196/60289 %U https://www.researchprotocols.org/2024/1/e60289 %U https://doi.org/10.2196/60289 %U http://www.ncbi.nlm.nih.gov/pubmed/39612491 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e64726 %T Strengthening the Backbone: Government-Academic Data Collaborations for Crisis Response %A Yang,Rick %A Yang,Alina %K data infrastructure %K data sharing %K cross-sector collaboration %K government-academic partnerships %K public health %K crisis response %D 2024 %7 28.11.2024 %9 %J JMIR Public Health Surveill %G English %X %R 10.2196/64726 %U https://publichealth.jmir.org/2024/1/e64726 %U https://doi.org/10.2196/64726 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e66479 %T Authors’ Reply to: Strengthening the Backbone: Government-Academic Data Collaborations for Crisis Response %A Lee,Jian-Sin %A Tyler,Allison R B %A Veinot,Tiffany Christine %A Yakel,Elizabeth %K COVID-19 %K crisis response %K cross-sector collaboration %K data infrastructures %K data science %K data sharing %K pandemic %K public health informatics %D 2024 %7 28.11.2024 %9 %J JMIR Public Health Surveill %G English %X %R 10.2196/66479 %U https://publichealth.jmir.org/2024/1/e66479 %U https://doi.org/10.2196/66479 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e58613 %T Homestay Hosting Dynamics and Refugee Well-Being: Scoping Review %A Al-Hamad,Areej %A Yasin,Yasin Mohammad %A Metersky,Kateryna %A Guruge,Sepali %A Jung,Grace %A Mahsud,Khadija %+ Toronto Metropolitan University, DCC544-288 Church Street, Toronto, ON, M5B 1Z5, Canada, 1 416 979 5044 ext 554727, areej.hamad@torontomu.ca %K homestay %K host-guest relationship %K hospitality %K hosting %K well-being %K homestay accommodation %K host-refugee relation %K refugee %K scoping review %K review %D 2024 %7 25.11.2024 %9 Review %J Interact J Med Res %G English %X Background: Homestay accommodations aim to support a smoother transition for refugees; yet, the intricate nature of relationships between refugees and their hosting families can make this process complex, which, in turn, can affect their health and well-being. It is crucial to grasp the experiences of both refugees and their host families in order to foster effective settlement, integration, and well-being. Objective: The purpose of this scoping review is to explore the dynamics of homestay or hosting with a focus on understanding the experiences of both refugees and their hosting families to identify gaps in the literature and propose directions for future research. Methods: We used the Joanna Briggs Institute methodology and followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist to guide this scoping review. Searches were conducted in MEDLINE via EBSCO, Scopus via OVID, CINAHL, SOCIndex, Web of Science Core Collection, ProQuest Dissertations and Theses, the SciELO Citation Index, and APA PsycInfo. Literature written in English and published from 2011 to 2024 that focused on homestay hosting contexts for refugees was included. Results: The results of this review illuminate the multifaceted and dynamic nature of homestay hosting for refugees. The findings include motivations and barriers for homestay hosting, factors influencing host-refugee relations, and psychological and social outcomes of homestay hosting. Conclusions: The results of this scoping review demonstrated the need for tailored support for refugees to improve homestay programs for the benefit of both refugees and host families and highlighted the need of more inclusive, supportive, and effective strategies for the hosting, resettlement, and integration of refugees. International Registered Report Identifier (IRRID): RR2-10.2196/56242 %M 39586073 %R 10.2196/58613 %U https://www.i-jmr.org/2024/1/e58613 %U https://doi.org/10.2196/58613 %U http://www.ncbi.nlm.nih.gov/pubmed/39586073 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59742 %T Elements Influencing User Engagement in Social Media Posts on Lifestyle Risk Factors: Systematic Review %A Yip,Yan Yee %A Makmor-Bakry,Mohd %A Chong,Wei Wen %+ Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, 50300, Malaysia, 60 39289711, weiwen@ukm.edu.my %K chronic disease %K health promotion %K internet %K primary prevention %K social media %K systematic reviews %K health care professional %K health personnel %K user engagement %K lifestyle %K risk %D 2024 %7 22.11.2024 %9 Review %J J Med Internet Res %G English %X Background: The high prevalence of noncommunicable diseases and the growing importance of social media have prompted health care professionals (HCPs) to use social media to deliver health information aimed at reducing lifestyle risk factors. Previous studies have acknowledged that the identification of elements that influence user engagement metrics could help HCPs in creating engaging posts toward effective health promotion on social media. Nevertheless, few studies have attempted to comprehensively identify a list of elements in social media posts that could influence user engagement metrics. Objective: This systematic review aimed to identify elements influencing user engagement metrics in social media posts by HCPs aimed to reduce lifestyle risk factors. Methods: Relevant studies in English, published between January 2006 and June 2023 were identified from MEDLINE or OVID, Scopus, Web of Science, and CINAHL databases. Included studies were those that examined social media posts by HCPs aimed at reducing the 4 key lifestyle risk factors. Additionally, the studies also outlined elements in social media posts that influenced user engagement metrics. The titles, abstracts, and full papers were screened and reviewed for eligibility. Following data extraction, narrative synthesis was performed. All investigated elements in the included studies were categorized. The elements in social media posts that influenced user engagement metrics were identified. Results: A total of 19 studies were included in this review. Investigated elements were grouped into 9 categories, with 35 elements found to influence user engagement. The 3 predominant categories of elements influencing user engagement were communication using supportive or emotive elements, communication aimed toward behavioral changes, and the appearance of posts. In contrast, the source of post content, social media platform, and timing of post had less than 3 studies with elements influencing user engagement. Conclusions: Findings demonstrated that supportive or emotive communication toward behavioral changes and post appearance could increase postlevel interactions, indicating a favorable response from the users toward posts made by HCPs. As social media continues to evolve, these elements should be constantly evaluated through further research. %M 39576982 %R 10.2196/59742 %U https://www.jmir.org/2024/1/e59742 %U https://doi.org/10.2196/59742 %U http://www.ncbi.nlm.nih.gov/pubmed/39576982 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e51214 %T Social Cohesion and COVID-19: Integrative Review %A Ware,Paul %+ Department of Social and Community Health, School of Population Health, University of Auckland, Park Road, Auckland, New Zealand, 64 99236549, paul.ware@auckland.ac.nz %K social cohesion %K social capital %K COVID-19 %K infrastructure %K tool %K social %K economic %K interpersonal %K interpersonal relationship %K emotions %K pandemic %K engagement %K health behaviors %K resilience %K emotional well-being %K well-being %D 2024 %7 21.11.2024 %9 Review %J Interact J Med Res %G English %X Background: Nations of considerable wealth and sophisticated health care infrastructures have experienced high rates of illness and death from COVID-19. Others with limited economic means and less developed health systems have achieved much lower burdens. To build a full understanding, an appraisal of the contribution of social relationships is necessary. Social cohesion represents a promising conceptual tool. Objective: This study aimed to examine scholarship on social cohesion during the COVID-19 pandemic: specifically, the constructions of social cohesion being deployed, the variables chosen for representation, and the effects of and on social cohesion being reported. Methods: The PubMed, Scopus, and JSTOR databases were searched for relevant journal articles and gray literature. A total of 100 studies met the inclusion criteria. Data were extracted and analyzed from these using spreadsheet software. Results: Several constructions of social cohesion were found. These concerned interpersonal relationships, sameness and difference, collective action, perceptions or emotions of group members, structures and institutions of governance, locally or culturally specific versions, and hybrid or multidimensional models. Social cohesion was reported to be influential on health outcomes, health behaviors, resilience, and emotional well-being, but there was some potential for it to drive undesirable outcomes. Scholarship reported increases or decreases in quantitative measures of social cohesion, a temporary “rally round the flag” effect early in the pandemic, the variable impacts of policy on social cohesion, and changing interpersonal relationships due to the pandemic conditions. There are numerous issues with the literature that reflect the well-documented limitations of popular versions of the concept. Conclusions: Social cohesion has been used to express a range of different aspects of relationships during the pandemic. It is claimed to promote better health outcomes, more engagement with positive health behaviors, and greater resilience and emotional well-being. The literature presents a range of ways in which it has been altered by the pandemic conditions. There are significant weaknesses to this body of knowledge that greatly impede its overall quality. %M 39571166 %R 10.2196/51214 %U https://www.i-jmr.org/2024/1/e51214 %U https://doi.org/10.2196/51214 %U http://www.ncbi.nlm.nih.gov/pubmed/39571166 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57476 %T Use of Digital Tools in Arbovirus Surveillance: Scoping Review %A Melo,Carolina Lopes %A Mageste,Larissa Rangel %A Guaraldo,Lusiele %A Paula,Daniela Polessa %A Wakimoto,Mayumi Duarte %+ Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil, 4365, Rio de Janeiro, 21040-900, Brazil, 55 2138659110, mayumi.wakimoto@ini.fiocruz.br %K arbovirus infections %K dengue %K zika virus %K chikungunya fever %K public health surveillance %K digital tool %K technology %D 2024 %7 18.11.2024 %9 Review %J J Med Internet Res %G English %X Background: The development of technology and information systems has led to important changes in public health surveillance. Objective: This scoping review aimed to assess the available evidence and gather information about the use of digital tools for arbovirus (dengue virus [DENV], zika virus [ZIKV], and chikungunya virus [CHIKV]) surveillance. Methods: The databases used were MEDLINE, SCIELO, LILACS, SCOPUS, Web of Science, and EMBASE. The inclusion criterion was defined as studies that described the use of digital tools in arbovirus surveillance. The exclusion criteria were defined as follows: letters, editorials, reviews, case reports, series of cases, descriptive epidemiological studies, laboratory and vaccine studies, economic evaluation studies, and studies that did not clearly describe the use of digital tools in surveillance. Results were evaluated in the following steps: monitoring of outbreaks or epidemics, tracking of cases, identification of rumors, decision-making by health agencies, communication (cases and bulletins), and dissemination of information to society). Results: Of the 2227 studies retrieved based on screening by title, abstract, and full-text reading, 68 (3%) studies were included. The most frequent digital tools used in arbovirus surveillance were apps (n=24, 35%) and Twitter, currently called X (n=22, 32%). These were mostly used to support the traditional surveillance system, strengthening aspects such as information timeliness, acceptability, flexibility, monitoring of outbreaks or epidemics, detection and tracking of cases, and simplicity. The use of apps to disseminate information to society (P=.02), communicate (cases and bulletins; P=.01), and simplicity (P=.03) and the use of Twitter to identify rumors (P=.008) were statistically relevant in evaluating scores. This scoping review had some limitations related to the choice of DENV, ZIKV, and CHIKV as arboviruses, due to their clinical and epidemiological importance. Conclusions: In the contemporary scenario, it is no longer possible to ignore the use of web data or social media as a complementary strategy to health surveillance. However, it is important that efforts be combined to develop new methods that can ensure the quality of information and the adoption of systematic measures to maintain the integrity and reliability of digital tools’ data, considering ethical aspects. %M 39556803 %R 10.2196/57476 %U https://www.jmir.org/2024/1/e57476 %U https://doi.org/10.2196/57476 %U http://www.ncbi.nlm.nih.gov/pubmed/39556803 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e53616 %T Benefits and Risks of AI in Health Care: Narrative Review %A Chustecki,Margaret %+ Department of Internal Medicine, Yale School of Medicine, 1952 Whitney Ave, 3rd Floor, New Haven, CT, 06510, United States, 1 2038091700, margaret.chustecki@imgnh.com %K artificial intelligence %K safety risks %K biases %K AI %K benefit %K risk %K health care %K safety %K ethics %K transparency %K data privacy %K accuracy %D 2024 %7 18.11.2024 %9 Review %J Interact J Med Res %G English %X Background: The integration of artificial intelligence (AI) into health care has the potential to transform the industry, but it also raises ethical, regulatory, and safety concerns. This review paper provides an in-depth examination of the benefits and risks associated with AI in health care, with a focus on issues like biases, transparency, data privacy, and safety. Objective: This study aims to evaluate the advantages and drawbacks of incorporating AI in health care. This assessment centers on the potential biases in AI algorithms, transparency challenges, data privacy issues, and safety risks in health care settings. Methods: Studies included in this review were selected based on their relevance to AI applications in health care, focusing on ethical, regulatory, and safety considerations. Inclusion criteria encompassed peer-reviewed articles, reviews, and relevant research papers published in English. Exclusion criteria included non–peer-reviewed articles, editorials, and studies not directly related to AI in health care. A comprehensive literature search was conducted across 8 databases: OVID MEDLINE, OVID Embase, OVID PsycINFO, EBSCO CINAHL Plus with Full Text, ProQuest Sociological Abstracts, ProQuest Philosopher’s Index, ProQuest Advanced Technologies & Aerospace, and Wiley Cochrane Library. The search was last updated on June 23, 2023. Results were synthesized using qualitative methods to identify key themes and findings related to the benefits and risks of AI in health care. Results: The literature search yielded 8796 articles. After removing duplicates and applying the inclusion and exclusion criteria, 44 studies were included in the qualitative synthesis. This review highlights the significant promise that AI holds in health care, such as enhancing health care delivery by providing more accurate diagnoses, personalized treatment plans, and efficient resource allocation. However, persistent concerns remain, including biases ingrained in AI algorithms, a lack of transparency in decision-making, potential compromises of patient data privacy, and safety risks associated with AI implementation in clinical settings. Conclusions: In conclusion, while AI presents the opportunity for a health care revolution, it is imperative to address the ethical, regulatory, and safety challenges linked to its integration. Proactive measures are required to ensure that AI technologies are developed and deployed responsibly, striking a balance between innovation and the safeguarding of patient well-being. %M 39556817 %R 10.2196/53616 %U https://www.i-jmr.org/2024/1/e53616 %U https://doi.org/10.2196/53616 %U http://www.ncbi.nlm.nih.gov/pubmed/39556817 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e63561 %T Barriers and Facilitators Affecting Access to Health Care for People With Syphilis: Protocol for a Scoping Review %A Correia,Rafaela Bezerra Façanha %A Mourad,Rafaela Prudlik %A Dantas,Janmilli da Costa %A Silva,Richardson Augusto Rosendo da %+ Department of Speech, Language and Hearing Disorders, Federal University of Rio Grande do Norte, Health Sciences Center UFRN, R. Gen. Gustavo Cordeiro de Faria, 601, Natal, 59070400, Brazil, 55 (84) 3342 9738, rafaela.facanha@ufrn.br %K syphilis %K acquired syphilis %K congenital syphilis %K gestational syphilis %K Treponema pallidum %K health services accessibility %K access to health services %K scoping review %D 2024 %7 15.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Syphilis is a systemic, preventable, and curable infection caused by the bacterium Treponema pallidum. Despite being treatable, syphilis continues to have a high incidence, with a resurgence observed even in countries with strong health surveillance systems. This highlights the need to understand the various strategies used globally to improve access to care for individuals with syphilis. Objective: This scoping review aims to identify and map the barriers and facilitators affecting access to health care for people with syphilis. Methods: This scoping review will follow the methodology outlined by the Joanna Briggs Institute. The search will be conducted across several databases, including PubMed/MEDLINE, Scopus, Embase, LILACS (Virtual Health Library), and CINAHL (EBSCO). In addition, sources of unpublished studies or gray literature will be explored. Studies focusing on access to health care for individuals with syphilis will be included, regardless of geographic location, country, or language. Two independent reviewers will assess the results, and data will be extracted using a tool specifically developed for this review. The extracted quantitative data will be presented in tables and analyzed using descending hierarchical classification, represented by a class dendrogram. Barriers and facilitators will be categorized into dimensions of access. Results: Database searching began in October 2024. Full-text screening and review are expected to be completed in December 2024. Data extraction and analysis are expected to be completed by February 2025, and the final report will be completed in March 2025. Conclusions: The findings of this scoping review, guided by this protocol, will elucidate the main barriers and facilitators that affect access to syphilis treatment. This study may contribute to the practices of health professionals, managers, and the academic community, and provide relevant information for the population. Trial Registration: Open Science Framework Registries osf.io/kpsab; https://osf.io/kpsab International Registered Report Identifier (IRRID): PRR1-10.2196/63561 %M 39547659 %R 10.2196/63561 %U https://www.researchprotocols.org/2024/1/e63561 %U https://doi.org/10.2196/63561 %U http://www.ncbi.nlm.nih.gov/pubmed/39547659 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e55865 %T Visual Modeling Languages in Patient Pathways: Scoping Review %A Bogale,Binyam %A Vesinurm,Märt %A Lillrank,Paul %A Celius,Elisabeth Gulowsen %A Halvorsrud,Ragnhild %+ Department of Neurology, Institute of Clinical Medicine, University of Oslo, Bldg 20, Ludvig Kastensvei 15, Oslo, 1064, Norway, 47 96711061, binyadad@gmail.com %K patient pathways %K visual modeling languages %K business process model and notation %K BPMN %K unified modeling language %K UML %K domain-specific modeling languages %K scoping review %D 2024 %7 15.11.2024 %9 Review %J Interact J Med Res %G English %X Background: Patient pathways (PPs) are presented as a panacea solution to enhance health system functions. It is a complex concept that needs to be described and communicated well. Modeling plays a crucial role in promoting communication, fostering a shared understanding, and streamlining processes. Only a few existing systematic reviews have focused on modeling methods and standardized modeling languages. There remains a gap in consolidated knowledge regarding the use of diverse visual modeling languages. Objective: This scoping review aimed to compile visual modeling languages used to represent PPs, including the justifications and the context in which a modeling language was adopted, adapted, combined, or developed. Methods: After initial experimentation with the keywords used to describe the concepts of PPs and visual modeling languages, we developed a search strategy that was further refined and customized to the major databases identified as topically relevant. In addition, we consulted gray literature and conducted hand searches of the referenced articles. Two reviewers independently screened the articles in 2 stages using preset inclusion criteria, and a third reviewer voted on the discordance. Data charting was done using an iteratively developed form in the Covidence software. Descriptive and thematic summaries were presented following rounds of discussion to produce the final report. Results: Of 1838 articles retrieved after deduplication, 22 satisfied our inclusion criteria. Clinical pathway is the most used phrase to represent the PP concept, and most papers discussed the concept without providing their operational definition. We categorized the visual modeling languages into five categories: (1) general purpose–modeling language (GPML) adopted without major extension or modification, (2) GPML used with formal extension recommendations, (3) combination of 2 or more modeling languages, (4) a developed domain-specific modeling language (DSML), and (5) ontological modeling languages. The justifications for adopting, adapting, combining, and developing visual modeling languages varied accordingly and ranged from versatility, expressiveness, tool support, and extensibility of a language to domain needs, integration, and simplification. Conclusions: Various visual modeling languages were used in PP modeling, each with varying levels of abstraction and granularity. The categorization we made could aid in a better understanding of the complex combination of PP and modeling languages. Standardized GPMLs were used with or without any modifications. The rationale to propose any modification to GPMLs evolved as more evidence was presented following requirement analyses to support domain constructs. DSMLs are infrequently used due to their resource-intensive development, often initiated at a project level. The justifications provided and the context where DSMLs were created are paramount. Future studies should assess the merits and demerits of using a visual modeling language to facilitate PP communications among stakeholders and use evaluation frameworks to identify, modify, or develop them, depending on the scope and goal of the modeling need. %M 39546800 %R 10.2196/55865 %U https://www.i-jmr.org/2024/1/e55865 %U https://doi.org/10.2196/55865 %U http://www.ncbi.nlm.nih.gov/pubmed/39546800 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59395 %T Trends in Exercise-Related Internet Search Keywords by Sex, Age, and Lifestyle: Infodemiological Study %A Uemura,Kosuke %A Miyagami,Taiju %A Saita,Mizue %A Uchida,Takuro %A Yuasa,Shun %A Kondo,Keita %A Miura,Shun %A Matsushita,Mizuki %A Shirai,Yuka %A Misawa,Richard Baku %A Naito,Toshio %+ Department of General Medicine, Faculty of Medicine, Juntendo University, 3-1-3 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan, 81 3 5802 1190, k.uemura.sh@juntendo.ac.jp %K exercise prescriptions %K sex %K age %K lifestyle %K internet search keywords %K infodemiology %K demographic %K physical activity %D 2024 %7 11.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Exercise prescription by physicians is beneficial for initiating or intensifying physical activity. However, providing specific exercise prescriptions is challenging; therefore, few physicians prescribe exercise. Objective: This infodemiological study aimed to understand trends in exercise-related internet search keywords based on sex, age, and environmental factors to help doctors prescribe exercise more easily. Methods: Search keyword volume was collected from Yahoo! JAPAN for 2022. Ten exercise-related terms were analyzed to assess exercise interest. Total search activities were analyzed by sex and age. Characteristic scores were based on the Japanese prefecture. By performing hierarchical cluster analysis, regional features were examined, and Kruskal-Wallis tests were used to assess relationships with population and industry data. Results: The top-searched term was “Pilates” (266,000 queries). Male individuals showed higher interest in activities such as “running” (25,400/40,700, 62.4%), “muscle training” (65,800/111,000, 59.3%), and “hiking” (23,400/40,400, 57.9%) than female individuals. Female individuals exhibited higher interest in “Pilates” (199,000/266,000, 74.8%), “yoga” (86,200/117,000, 73.7%), and “tai chi” (45,300/65,900, 68.7%) than male individuals. Based on age, search activity was highest in the 40-49 years age group for both male and female individuals across most terms. For male individuals, 7 of the 10 searched terms’ volume peaked for those in their 40s; “stretch” was most popular among those in their 50s; and “tai chi” and “radio calisthenics” had the highest search volume for those in their 70s. Female individuals in their 40s led the search volume for 9 of the 10 terms, with the exception of “tai chi,” which peaked for those in their 70s. Hierarchical cluster analysis using a characteristic score as a variable classified prefectures into 4 clusters. The characteristics of these clusters were as follows: cluster 1 had the largest population and a thriving tertiary industry, and individuals tended to search for Pilates and yoga. Following cluster 1, cluster 2, with its substantial population, had a thriving secondary industry, with searches for radio calisthenics and exercise bike. Cluster 4 had a small population, a thriving primary industry, and the lowest search volume for any term. Cluster 3 had a similar population to that of cluster 4 but had a larger secondary industry. Conclusions: Male individuals show more interest in individual activities, such as running, whereas female individuals are interested in group activities, such as Pilates. Despite the high search volume among individuals in their 40s, actual exercise habits are low among those in their 30s to 50s. Search volumes for instructor-led exercises are higher in cluster 1 than in other cluster areas, and the total number of searches decreases as the community size decreases. These results suggest that trends in search behavior depending on sex, age, and environment factors are essential when prescribing exercise for effective behavioral change. %M 39527804 %R 10.2196/59395 %U https://formative.jmir.org/2024/1/e59395 %U https://doi.org/10.2196/59395 %U http://www.ncbi.nlm.nih.gov/pubmed/39527804 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55555 %T Tobacco and Alcohol Content in Top Vietnamese YouTube Music Videos: Content Analysis %A Tran,Thi Phuong Thao %A Vu,Thu Trang %A Li,Yachao %A Popova,Lucy %+ School of Public Health, Georgia State University, 140 Decatur St. SE, Atlanta, GA, 30303, United States, 1 4709626086, ttran217@gsu.edu %K risk %K risk factor %K tobacco content %K alcohol content %K tobacco %K alcohol %K tobacco portrayal %K alcohol portrayal %K music video %K Vietnam %K Vietnamese %K YouTube %K social media %K socials %K youth %K adolescent %K teen %K teenager %K young adult %D 2024 %7 8.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Seeing portrayals of tobacco and alcohol in music videos (MVs) may reduce perceived risks, increase susceptibility, and lead to the initiation of tobacco and alcohol use among adolescents and young adults. Previous studies have predominantly concentrated on assessing tobacco and alcohol contents in English-language MVs within Western countries. However, many other countries have not only been influenced by the English music market but have also produced music in their native languages, and this content remains underexamined. Objective: This study aims to investigate the prevalence of tobacco- and alcohol-related content in top Vietnamese MVs on YouTube from 2013 to 2021, to describe how tobacco and alcohol are portrayed in these MVs, and to examine associations between these portrayals and MV characteristics. Methods: A total of 410 Vietnamese MVs, including the top 40 or 50 most viewed released each year between 2013 and 2021, were analyzed. General information, such as the song name, its release date and ranking, age restriction, musical genre, and type of MV, was collected. We examined tobacco and alcohol content in the MVs, with specific details such as tobacco types, their brands, as well as the number, age, sex, and roles of individuals smoking or drinking. Results: Among the 410 MVs, 36 (8.8%) contained tobacco-related content and 136 (33.2%) featured alcohol-related content. Additionally, 28 (6.8%) out of 410 MVs included both tobacco and alcohol content. The prevalence of videos with tobacco and alcohol content fluctuated over the years. In MVs with tobacco-related content, a higher proportion of hip-hop or rap songs contained tobacco-related content (n=6, 30%) compared to other music genres. In MVs with tobacco-related content, cigarettes were the most frequently shown product (n=28, 77.8%), and smoking scenes were often depicted at parties (n=13, 36.1%) and during dancing and singing scenes (n=12, 33.3%). Among the 31 MVs portraying actual tobacco use, tobacco use was typically depicted with 1 person, often a young adult male, while 38.7% (n=12) showed singer(s) smoking. For MVs with alcohol-related content, there was a high proportion showing alcohol images at parties, bars, or pubs (n=96, 70.6%). Among 87 MVs containing drinking scenes, 60.9% (n=53) involved groups of young adults of both sexes, and 64% (n=56) depicted singers drinking. Additionally, only 2 (5.6%) MVs included health warnings about tobacco harm, and 2 MVs (1.5%) included warnings about drinking restricted to individuals 18 years and above. Conclusions: The notable prevalence of tobacco and alcohol content in leading Vietnamese YouTube MVs raises concerns, especially as most of this content is portrayed without any warnings. The study underscores a regulatory gap in addressing such content on the internet, emphasizing the urgent need for stricter regulations and age restrictions on platforms such as YouTube. %M 39514854 %R 10.2196/55555 %U https://www.jmir.org/2024/1/e55555 %U https://doi.org/10.2196/55555 %U http://www.ncbi.nlm.nih.gov/pubmed/39514854 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55311 %T The Validity of Impressions as a Media Dose Metric in a Tobacco Public Education Campaign Evaluation: Observational Study %A Davis,Kevin %A Curry,Laurel %A Bradfield,Brian %A Stupplebeen,David A %A Williams,Rebecca J %A Soria,Sandra %A Lautsch,Julie %+ RTI International, 701 13th St. NW, Ste 750, Washington, DC, 20005, United States, 1 202 728 2086, lcurry@rti.org %K communication %K public education %K tobacco %K media %K public health %D 2024 %7 5.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Evaluation research increasingly needs alternatives to target or gross rating points to comprehensively measure total exposure to modern multichannel public education campaigns that use multiple channels, including TV, radio, digital video, and paid social media, among others. Ratings data typically only capture delivery of broadcast media (TV and radio) and excludes other channels. Studies are needed to validate objective cross-channel metrics such as impressions against self-reported exposure to campaign messages. Objective: This study aimed to examine whether higher a volume of total media campaign impressions is predictive of individual-level self-reported campaign exposure in California. Methods: We analyzed over 3 years of advertisement impressions from the California Tobacco Prevention Program’s statewide tobacco education campaigns from August 2019 through December 2022. Impressions data varied across designated market areas (DMAs) and across time. These data were merged to individual respondents from 45 waves of panel survey data of Californians aged 18-55 years (N=151,649). Impressions were merged to respondents based on respondents’ DMAs and time of survey completion. We used logistic regression to estimate the odds of respondents’ campaign recall as a function of cumulative and past 3-month impressions delivered to each respondent’s DMA. Results: Cumulative impressions were positively and significantly associated with recall of each of the Flavors Hook Kids (odds ratio [OR] 1.15, P<.001), Dark Balloons and Apartment (OR 1.20, P<.001), We Are Not Profit (OR 1.36, P<.001), Tell Your Story (E-cigarette, or Vaping, product use Associated Lung Injury; OR 1.06, P<.05), and Thrown Away and Little Big Lies (OR 1.05, P<.01) campaigns. Impressions delivered in the past 3 months were associated with recall of the Flavors Hook Kids (OR 1.13, P<.001), Dark Balloons and Apartment (OR 1.08, P<.001), We Are Not Profit (OR 1.14, P<.001), and Thrown Away and Little Big Lies (OR 1.04, P<.001) campaigns. Past 3-month impressions were not significantly associated with Tell Your Story campaign recall. Overall, magnitudes of these associations were greater for cumulative impressions. We visualize recall based on postestimation predicted values from our multivariate logistic regression models. Conclusions: Variation in cumulative impressions for California Tobacco Prevention Program’s long-term multichannel tobacco education campaign is predictive of increased self-reported campaign recall, suggesting that impressions may be a valid proxy for potential campaign exposure. The use of impressions for purposes of evaluating public education campaigns may help address current methodological limitations arising from the fragmented nature of modern multichannel media campaigns. %M 39499542 %R 10.2196/55311 %U https://www.jmir.org/2024/1/e55311 %U https://doi.org/10.2196/55311 %U http://www.ncbi.nlm.nih.gov/pubmed/39499542 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60025 %T Advancing the United Nations Sustainable Development Goals Through Digital Health Research: 25 Years of Contributions From the Journal of Medical Internet Research %A Raman,Raghu %A Singhania,Monica %A Nedungadi,Prema %+ Amrita School of Business, Amrita School of Computing, Amrita Vishwa Vidyapeetham, Amritapuri, Kerala, 690525, India, 91 9895028779, raghu@amrita.edu %K sustainable development goal %K topic modeling %K public health %K surveillance %K gender equality %K non-communicable disease %K social media %K COVID-19 %K SARS-CoV-2 %K coronavirus %K machine learning %K artificial intelligence %K AI %K digital health %D 2024 %7 4.11.2024 %9 Research Letter %J J Med Internet Res %G English %X %M 39496147 %R 10.2196/60025 %U https://www.jmir.org/2024/1/e60025 %U https://doi.org/10.2196/60025 %U http://www.ncbi.nlm.nih.gov/pubmed/39496147 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56386 %T Relationships Among eHealth Literacy, Physical Literacy, and Physical Activity in Chinese University Students: Cross-Sectional Study %A Jiang,Shan %A Ng,Johan Y Y %A Choi,Siu Ming %A Ha,Amy S %+ Department of Sport Science and Physical Education, The Chinese University of Hong Kong, G05 Kwok Sports Building, Shatin, N.T., Hong Kong, China (Hong Kong), 852 39436083, sauchingha@cuhk.edu.hk %K eHealth literacy %K physical literacy %K physical activity %K university students %K health behavior %D 2024 %7 4.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth literacy is critical for evaluating abilities in locating, accessing, and applying digital health information to enhance one’s understanding, skills, and attitudes toward a healthy lifestyle. Prior research indicates that enhancing eHealth literacy can improve health behaviors such as physical activity (PA). Physical literacy (PL) refers to the ability to develop sustainable PA habits, taking into account various aspects of an individual. Notably, university students have shown a decline in PA and possess low PL levels. However, the connection between eHealth literacy and PL in this demographic has not been extensively studied, and it remains uncertain whether PA acts as a mediator between eHealth literacy and PL. Objective: This study examines the extent to which PA mediates the link between eHealth literacy and PL in Chinese university students and explores gender differences in these variables. Methods: In February 2022, a cross-sectional survey was administered to 1210 students across 3 universities in China. The instruments used were the Perceived PL Instrument, the International Physical Activity Questionnaire, and the Chinese version of the eHealth Literacy Scale. Correlations between eHealth literacy, PA, and PL were analyzed using Pearson product-moment correlation and multiple linear regression, while mediation models helped elucidate the interactions among the 3 variables. Results: The response rate for the study was 92.9% (1124/1210). In the mediation analysis, eHealth literacy showed a significant direct effect on PL, with a coefficient of 0.78 (β .75, SE 0.02; P<.001). Moderate to vigorous physical activity (MVPA) accounted for 2.16% of the total effect, suggesting that MVPA partially mediates the relationship between eHealth literacy and PL. Additionally, male students outperformed female students in terms of MVPA (t636=4.94; P<.001) and PL (t636=3.18; P<.001), but no significant differences were found in eHealth literacy (t636=1.23; P=.22). Conclusions: The findings indicate that MVPA serves as a mediator in the link between eHealth literacy and PL among university students. Students with low eHealth literacy or limited PA are less likely to be physically literate. Thus, eHealth literacy plays a crucial role in enhancing PL and PA, especially when interventions targeting PL are implemented. Our results also suggest a need for targeted health education interventions aimed at improving MVPA and PL among female students, while also recognizing that eHealth literacy is comparable across genders at universities. %M 39496161 %R 10.2196/56386 %U https://www.jmir.org/2024/1/e56386 %U https://doi.org/10.2196/56386 %U http://www.ncbi.nlm.nih.gov/pubmed/39496161 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57886 %T The Implementation of the Advocacy Intervention for Midlife and Older Women Who Have Experienced Intimate Partner Violence: Protocol for a Randomized Controlled Trial %A Weeks,Lori %A Allen,Kathleen %A Holtmann,Catherine %A Leger,Joni %A Dupuis-Blanchard,Suzanne %A MacQuarrie,Colleen %A Macdonald,Marilyn %A Moody,Elaine %A Stilwell,Christie %A Helpard,Heather %A Gagnon,Danie %+ School of Health Administration, Dalhousie University, Sir Charles Tupper Medical Building, 2nd Floor, 5850 College Street, PO Box 15000, Halifax, NS, B3H 4R2, Canada, 1 902 494 7114, lori.weeks@dal.ca %K intimate partner violence %K intervention %K virtual %K midlife %K aging %D 2024 %7 30.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Midlife and older women who experience intimate partner violence (IPV) often have less access to supports and services than younger women. There is far less focus on research and supports for midlife and older women compared to younger women experiencing IPV, and often, neither elder abuse nor IPV services meet their needs. Few interventions are available to meet the needs of midlife and older women. Objective: The goal of this randomized controlled trial is to test the effectiveness of an advocacy intervention for midlife and older women who experience IPV and to learn from the experiences of those who implement and participate in the program. Methods: This trial is a 2-arm, unblinded, parallel, pragmatic randomized controlled trial with a qualitative component. Eligible participants will be women who live in the Maritime provinces of Canada (New Brunswick, Nova Scotia, and Prince Edward Island), who are in midlife and older (aged approximately ≥50 years), and who are currently in a relationship with an abusive partner or have recently left an abusive partner. Facilitators will be trained to deliver the intervention. The intervention will be entirely virtual and will consist of 2 components: (1) an empowerment component, which will involve sharing resources and information with the women; and (2) a social support component, which will include providing support and encouragement to women for 12 weeks. Quantitative effectiveness data will be collected from all trial participants at baseline, 3 months after the intervention, and 9 months after the intervention about the incidence and severity of IPV, physical and mental health, and safety behaviors and strategies. Qualitative interviews will be conducted with the facilitators and intervention group participants. Control group participants will receive a static, nontailored version of the advocacy intervention for midlife and older women (AIM) intervention materials after baseline data collection. Results: A total of 12 facilitators have been trained to deliver the AIM intervention to trial participants. Participant recruitment and data collection will be completed in January 2025. Data analysis will continue throughout the data collection period, and the results will be disseminated by December 2025. Conclusions: This research will result in the adaptation and testing of a program to support and empower midlife and older women in the Maritime provinces of Canada who experience IPV. Trial Registration: International Standard Randomized Controlled Trial Registry ISRCTN30646991; https://doi.org/10.1186/ISRCTN30646991 International Registered Report Identifier (IRRID): DERR1-10.2196/57886 %M 39476849 %R 10.2196/57886 %U https://www.researchprotocols.org/2024/1/e57886 %U https://doi.org/10.2196/57886 %U http://www.ncbi.nlm.nih.gov/pubmed/39476849 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55029 %T Effects of Injury Registry Data on Policy Making, Hospitalizations, and Mortality: Protocol for a Systematic Review and Meta-Analysis %A Medeiros-de-Souza,Ana Cláudia %A Lopes,Luana Emanuelly Sinhori %A de Oliveira,Bruno Zocca %A Rother,Edna Terezinha %A Correia,Lucas Reis %+ Hospital Israelita Albert Einstein, 755 Comendador Elias Jafet Street, L1 Floor, Room 134, Sao Paulo, 05653-000, Brazil, 55 11989249946, ana.cms@einstein.br %K injury registry %K trauma registry %K policy making %K health policy %K wounds and injuries %K outcome assessments, health surveillance %K hospitalizations %K mortality %D 2024 %7 30.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Initiated in 2021, a Brazilian project aims to establish a national injury registry, compiling comprehensive data on events and individuals across the country, irrespective of injury severity. The registry integrates information from prehospital and hospital care, diverse health systems lacking interoperability, and sectors such as firefighters and the police. Its primary goal is to enhance health surveillance by providing timely, high-quality information, guiding prevention strategies, and informing policy making. The project still aims to reduce long-term morbidity and mortality associated with injuries. Objective: A knowledge gap remains regarding the effects of injury registries in relation to policies and injury outcomes. This protocol outlines a systematic review and meta-analysis to answer “What is the effect of implementation and use of injury registry data on policy making, hospitalization, and mortality?” Methods: The systematic review follows PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, focusing on studies reporting results related to the implementation and use of injury registries, including trauma registries. Outcomes of interest include policy making, hospitalization rates or duration, and mortality. Registries within well-defined administrative boundaries will be included. Data will be collected from PubMed, Embase, Scopus, Web of Science, Lilacs, and references. Records will be independently screened by 2 reviewers, with any disagreements resolved through arbitration by a third reviewer. Homogeneous studies, with 3 or more evaluating the same outcome, may undergo meta-analysis. Subgroup analyses by registry type, injury groups, and other selected variables of interest will be conducted. Sensitivity analysis, risk of bias assessment, publication bias evaluation, and quality appraisal will also be performed. Results: This systematic review will run from November 2023 to June 2024. No identical review was found. Search strategies were finalized, the bibliographic search started, duplicates were eliminated, and title and abstract screening began. Of 35 studies retrieved, 85 were excluded due to duplication, leaving 50 for selection. Conclusions: This study is timely, aligning with ongoing national efforts to implement an injury registry. By synthesizing available evidence, we will identify the potential of injury registries to guide the decisions of Brazilian policy makers. Trial Registration: PROSPERO CRD42023481528; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=481528 International Registered Report Identifier (IRRID): PRR1-10.2196/55029 %M 39475822 %R 10.2196/55029 %U https://www.researchprotocols.org/2024/1/e55029 %U https://doi.org/10.2196/55029 %U http://www.ncbi.nlm.nih.gov/pubmed/39475822 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53938 %T Discussion of Heated Tobacco Products on Twitter Following IQOS’s Modified-Risk Tobacco Product Authorization and US Import Ban: Content Analysis %A Kim,Minji %A Vassey,Julia %A Li,Dongmei %A Galimov,Artur %A Han,Eileen %A Kirkpatrick,Matthew G %A Stanton,Cassandra A %A Ozga,Jenny E %A Lee,Sarah %A Unger,Jennifer B %+ Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Suite 554, Columbia, SC, 29208, United States, 1 803 777 1904, minjikim@sc.edu %K heated tobacco products %K IQOS %K social media %K Twitter %K tobacco control %K modified-risk tobacco product authorization %K MRTP authorization %K tobacco regulatory science %K import ban %K observational study %K public opinion %K content analysis %D 2024 %7 24.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Understanding public opinions about emerging tobacco products is important to inform future interventions and regulatory decisions. Heated tobacco products (HTPs) are an emerging tobacco product category promoted by the tobacco industry as a “better alternative” to combustible cigarettes. Philip Morris International’s IQOS is leading the global HTP market and recently has been subject to important policy events, including the US Food and Drug Administration’s (FDA) modified-risk tobacco product (MRTP) authorization (July 2020) and the US import ban (November 2021). Although limited in their legal implications outside the United States, these policy events have been quoted in global news outlets and Philip Morris International’s promotional communications, showing how they may potentially impact global tobacco regulation. Given the impending return of IQOS to the US market, understanding how the policy events were received through social media discourse will provide valuable insights to inform global tobacco control policy. Objective: This study aims to examine HTP-related social media discourse around important policy events. Methods: We analyzed HTP-related posts on Twitter during the time period that included IQOS’s MRTP authorization in the United States and the US import ban, examining personal testimonial, news/information, and direct marketing/retail tweets separately. We also examined how the tweets discussed health and policy. A total of 10,454 public English tweets (posted from June 2020 to December 2021) were collected using HTP-related keywords. We randomly sampled 2796 (26.7%) tweets and conducted a content analysis. We used pairwise co-occurrence analyses to evaluate connections across themes. Results: Tweet volumes peaked around IQOS-related policy events. Among all tweets, personal testimonials were the most common (1613/2796, 57.7%), followed by news/information (862/2796, 30.8%) and direct marketing/retail (321/2796, 11%). Among personal testimonials, more tweets were positive (495/1613, 30.7%) than negative (372/1613, 23.1%), often comparing the health risks of HTPs with cigarettes (402/1613, 24.9%) or vaping products (252/1613, 15.6%). Approximately 10% (31/321) of the direct marketing/retail tweets promoted international delivery, suggesting cross-border promotion. More than a quarter of tweets (809/2796, 28.9%) discussed US and global policy, including misinterpretation about IQOS being a “safer” tobacco product after the US FDA’s MRTP authorization. Neutral testimonials mentioning the IQOS brand (634/1613, 39.3%) and discussing policy (378/1613, 23.4%) showed the largest pairwise co-occurrence. Conclusions: Results suggest the need for careful communication about the meaning of MRTP authorizations and relative risks of tobacco products. Many tweets expressed HTP-favorable opinions referring to reduced health risks, even though the US FDA has denied marketing of the HTP with reduced risk claims. The popularity of social media as an information source with global reach poses unique challenges in health communication and health policies. While many countries restrict tobacco marketing via the web, our results suggest that retailers may circumvent such regulations by operating overseas. %M 39446431 %R 10.2196/53938 %U https://www.jmir.org/2024/1/e53938 %U https://doi.org/10.2196/53938 %U http://www.ncbi.nlm.nih.gov/pubmed/39446431 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56469 %T Surveillance of Food and Waterborne Pathogens in North-East India: Protocol for a Laboratory-Based Sentinel Surveillance Study %A Albert,Venencia %A Ramamurthy,Thandavarayan %A Das,Madhuchhanda %A Das,Samaresh %A Ojha,Anup Kumar %A Sarmah,Pallab %A Gogoi,Dimpu %A Dolma,Karma G %A Majumdar,Tapan %A Sarangthem,Indira %A Dutta,Tapan %A Hazarika,Suranjana Chaliha %+ Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029, India, 91 9643690074, dasm.hq@icmr.gov.in %K foodborne diseases %K enteric pathogens %K surveillance %K food safety %K outbreak %K antimicrobial resistance %K public health %D 2024 %7 21.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Food safety is a global concern, which is often underestimated owing to challenges in investigating foodborne diseases. These challenges arise from the increased globalization of the food trade, advancements in agricultural practices, and shifts in environmental factors. In North-East India, common diarrheal outbreaks from fermented foods pose significant health risks. Despite these challenges, systematic data on foodborne pathogens is lacking in India, highlighting a crucial gap in understanding food safety issues. Objective: The aim of this research protocol is to establish an integrated surveillance system to identify enteric pathogens circulating within humans, food animals, and the environment through a health approach in North-East India, and to conduct outbreak investigations. Methods: The Indian Council of Medical Research (ICMR) initiated a surveillance study across all 8 North-East states in India, employing a centralized digital database for data collation. The project aims to enhance the infrastructure for microbial culture, antibiotic sensitivity testing, and molecular epidemiological studies. The study involves laboratory-based surveillance of foodborne pathogens in market foods, hospitalized diarrheal patients, poultry and animal farms, slaughterhouses, butcher shops, and diarrheal outbreaks. A standardized case report form ensures consistent data collection of age, sex, signs, symptoms, and admission dates for diarrheal cases. Stool and rectal swabs will undergo testing for pathogen identification and antimicrobial resistance. Similarly, samples of market foods, food animals, and the environment will be collected. Outbreaks confirmed by the Integrated Disease Surveillance Project (IDSP) will be thoroughly investigated following standardized guidelines. Results: In phase I, 5 surveillance centers were established across 4 states (ie, Assam [Dibrugarh and Guwahati], Tripura, Sikkim, and Arunachal Pradesh) in 2020. Following an interim phase I data assessment and the successful establishment of a streamlined system for data procurement, investigation, recording, and analysis, along with the implementation of regular training and monitoring programs, phase II expansion was initiated in 2023-24. This includes the addition of 7 more centers (including 3 veterinary centers) in the remaining 4 states (ie, Manipur, Meghalaya, Mizoram, and Nagaland), eventually covering the entire North-Eastern Region of India. Conclusions: Food and waterborne diseases are a constant public health problem in many countries. Key challenges to the enhancement of food safety policy include the paucity of systematic data and awareness. With this background, ICMR’s initiative is the first systematic surveillance study in the country to adopt a single health approach. Data obtained from this project will help to understand the risk of acquiring food and waterborne pathogens, their transmission pathways, and antimicrobial resistance patterns. The scientific evidence generated through this project will be helpful in formulating and strengthening food safety policy and in initiating government programs to protect the health of the nation. International Registered Report Identifier (IRRID): DERR1-10.2196/56469 %M 39432901 %R 10.2196/56469 %U https://www.researchprotocols.org/2024/1/e56469 %U https://doi.org/10.2196/56469 %U http://www.ncbi.nlm.nih.gov/pubmed/39432901 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e56207 %T Dynamics of Blood Lipids Before, During, and After Diurnal Fasting in Inactive Men: Quasi-Experimental Study %A Aljaloud,Khalid %A Al-Barha,Naif %A Noman,Abeer %A Aldayel,Abdulaziz %A Alsharif,Yahya %A Alshuwaier,Ghareeb %+ Department of Exercise Physiology, College of Sport Sciences and Physical Activity, King Saud University, P O Box 2454, Riyadh, 11451, Saudi Arabia, 966 0118063100, khaljaloud@ksu.edu.sa %K cardiovascular diseases %K cardiovascular risk factors %K lipids %K glucose measurement %K fasting %K Ramadan %K body composition %D 2024 %7 17.10.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: There is a lack of investigation into the dynamics of blood lipids before, during, and after diurnal fasting, especially in inactive men. Objective: This study determined dynamic changes in blood lipids in inactive men before, during, and after they underwent diurnal fasting. Methods: A total of 44 young men aged a mean 27.6 (SD 5.8) years were recruited to evaluate their habitual physical activity and diet using a questionnaire developed for this study. Body composition was evaluated using a bioelectrical impedance analysis machine (Tanita BC-980). An 8-ml blood sample was collected to evaluate blood lipids and glucose. All measurements were taken 2-3 days before Ramadan, during Ramadan (at week 2 and week 3), and 1 month after Ramadan. A 1-way repeated measures ANOVA was used to compare the measured variables before, during, and after the month of Ramadan. When a significant difference was found, post hoc testing was used. Differences were considered significant at P<.05. Results: There was a significant reduction in low-density lipoprotein during Ramadan compared to before and after Ramadan (83.49 mg/dl at week 3 vs 93.11 mg/dl before Ramadan [P=.02] and 101.59 mg/dl after Ramadan [P=.007]). There were significant elevations in fasting blood glucose (74.60 mmol/L before Ramadan vs 81.52 mmol/L at week 3 [P=.03] and 86.51 mmol/L after Ramadan [P=.01]) and blood pressure (109 mm Hg before Ramadan vs 114 mm Hg after Ramadan; P=.02) reported during and even after the month of Ramadan, although both fasting blood glucose and blood pressure were within normal levels. Conclusions: Ramadan fasting could be an independent factor in reducing low-density lipoprotein. Further investigations are encouraged to clarify the impact of diurnal fasting on blood lipids in people with special conditions. %M 39419506 %R 10.2196/56207 %U https://www.i-jmr.org/2024/1/e56207 %U https://doi.org/10.2196/56207 %U http://www.ncbi.nlm.nih.gov/pubmed/39419506 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e57948 %T Projections of Climate Change Impact on Acute Heat Illnesses in Taiwan: Case-Crossover Study %A Yang,Hsiao-Yu %A Wu,Chang-Fu %A Tsai,Kun-Hsien %K climate change %K global warming %K heat-related illness %K carbon reduction %K heat %K heat illness %K extreme heat %K Taiwan %K real time %K epidemic %K surveillance %K public health %K emergency department %K early warning system %K nonlinear model %K temperature %K socioeconomic %K environmental health %K heat stress %K environmental %K epidemiology %D 2024 %7 16.10.2024 %9 %J JMIR Public Health Surveill %G English %X Background: With global warming, the number of days with extreme heat is expected to increase and may cause more acute heat illnesses. While decreasing emissions may mitigate the climate impacts, its effectiveness in reducing acute heat illnesses remains uncertain. Taiwan has established a real-time epidemic surveillance and early warning system to monitor acute heat illnesses since January 1, 2011. Predicting the number of acute heat illnesses requires forecasting temperature changes that are influenced by adaptation policies. Objective: The aim of this study was to estimate the changes in the number of acute heat illnesses under different adaptation policies. Methods: We obtained the numbers of acute heat illnesses in Taiwan from January 2011 to July 2023 using emergency department visit data from the real-time epidemic surveillance and early warning system. We used segmented linear regression to identify the join point as a nonoptimal temperature threshold. We projected the temperature distribution and excess acute heat illnesses through the end of the century when Taiwan adopts the “Sustainability (shared socioeconomic pathways 1‐2.6 [SSP1-2.6]),” “Middle of the road (SSP2-4.5),” “Regional rivalry (SSP3-7.0),” and “Fossil-fueled development (SSP5-8.5)” scenarios. Distributed lag nonlinear models were used to analyze the attributable number (AN) and attributable fraction (AF) of acute heat illnesses caused by nonoptimal temperature. Results: We enrolled a total of 28,661 patients with a mean age of 44.5 (SD 15.3) years up to July 2023, of whom 21,619 (75.4%) were male patients. The nonoptimal temperature was 27 °C. The relative risk of acute heat illnesses with a 1-degree increase in mean temperature was 1.71 (95% CI 1.63-1.79). In the SSP5-8.5 worst-case scenario, the mean temperature was projected to rise by +5.8 °C (SD 0.26), with the AN and AF of acute heat illnesses above nonoptimal temperature being 19,021 (95% CI 2249‐35,792) and 89.9% (95% CI 89.3%‐90.5%) by 2090‐2099. However, if Taiwan adopts the Sustainability SSP1-2.6 scenario, the AN and AF of acute heat illnesses due to nonoptimal temperature will be reduced to 12,468 (95% CI 3233‐21,704) and 62.1% (95% CI 61.2‐63.1). Conclusions: Adopting sustainable development policies can help mitigate the risk of acute heat illnesses caused by global warming. %R 10.2196/57948 %U https://publichealth.jmir.org/2024/1/e57948 %U https://doi.org/10.2196/57948 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e58564 %T Temporal Trends in the Prevalence of Child Undernutrition in China From 2000 to 2019, With Projections of Prevalence in 2030: Cross-Sectional Analysis %A Zhang,Zeyu %A Li,Sijia %A Zhai,Zidan %A Qiu,Ting %A Zhou,Yu %A Zhang,Heng %+ Department of Child Health Care, Wuxi Maternity and Child Health Care Hospital, 48 Huaishu Lane, Wuxi, 214002, China, 86 13812037731, zhanghengdev@126.com %K child growth failure %K undernutrition %K stunting %K wasting %K underweight %K trends %K projections %D 2024 %7 9.10.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Although the problem of malnutrition among children in China has greatly improved in recent years, there is a gap compared to developed countries, and there are differences between provinces. Research on long-term comprehensive trends in child growth failure (CGF) in China is needed for further improvement. Objective: The purpose of this study was to examine trends in stunting, wasting, and underweight among children younger than 5 years in China from 2000 to 2019, and predict CGF till 2030. Methods: We conducted a cross-sectional analysis using data from the local burden of disease (LBD) database. Using Joinpoint Regression Software, we examined trends in CGF among children younger than 5 years in China from 2000 to 2019, and predicted the trends of prevalence in 2030, using the Holt-Winters model with trends but without seasonal components. The assessment was performed with Stata 17 (StataCorp). Data were analyzed from October 17, 2023, to November 22, 2023. Results: In 2019, the prevalences of stunting, wasting, and underweight decreased to 12%, 3%, and 4%, respectively (decreases of 36.9%, 25.0%, and 42.9%, respectively, compared with the values in 2000). The prevalence of CGF decreased rapidly from 2000 to 2010, and the downward trend slowed down after 2010. Most provinces had stagnated processes of trends after 2017. The age group with the highest stunting prevalence was children aged 1 to 4 years, and the highest prevalence of wasting and underweight was noted in early neonatal infants. From 2000 to 2019, the prevalence of CGF declined in all age groups of children. The largest relative decrease in stunting and underweight was noted in children aged 1 to 4 years, and the largest decrease in wasting was noted in early neonatal infants. The prevalences of stunting, wasting, and underweight in China are estimated to decrease to 11.4%, 3.2%, and 4.1%, respectively, by 2030. China has nationally met the World Health Organization’s Global Nutrition Targets for 2030 for stunting but not for wasting. Conclusions: This study provides data on the prevalence and trends of CGF among children younger than 5 years and reports declines in CGF. There remain areas with slow progress in China. Most units have achieved the goal for stunting prevalence but not wasting prevalence. %M 39382950 %R 10.2196/58564 %U https://publichealth.jmir.org/2024/1/e58564 %U https://doi.org/10.2196/58564 %U http://www.ncbi.nlm.nih.gov/pubmed/39382950 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e47370 %T Changes in the Epidemiological Features of Influenza After the COVID-19 Pandemic in China, the United States, and Australia: Updated Surveillance Data for Influenza Activity %A Jiang,Mingyue %A Jia,Mengmeng %A Wang,Qing %A Sun,Yanxia %A Xu,Yunshao %A Dai,Peixi %A Yang,Weizhong %A Feng,Luzhao %+ School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, 31 Beiji Tower, Dongcheng District, Beijing, 100730, China, 86 10 65120716, fengluzhao@cams.cn %K influenza %K seasonal variation %K COVID-19 pandemic %K stringency index %D 2024 %7 9.10.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: There has been a global decrease in seasonal influenza activity since the onset of the COVID-19 pandemic. Objective: We aimed to describe influenza activity during the 2021/2022 season and compare it to the trends from 2012 to 2023. We also explored the influence of social and public health prevention measures during the COVID-19 pandemic on influenza activity. Methods: We obtained influenza data from January 1, 2012, to February 5, 2023, from publicly available platforms for China, the United States, and Australia. Mitigation measures were evaluated per the stringency index, a composite index with 9 measures. A general additive model was used to assess the stringency index and the influenza positivity rate correlation, and the deviance explained was calculated. Results: We used over 200,000 influenza surveillance data. Influenza activity remained low in the United States and Australia during the 2021/2022 season. However, it increased in the United States with a positive rate of 26.2% in the 49th week of 2022. During the 2021/2022 season, influenza activity significantly increased compared with the previous year in southern and northern China, with peak positivity rates of 28.1% and 35.1% in the second week of 2022, respectively. After the COVID-19 pandemic, the dominant influenza virus genotype in China was type B/Victoria, during the 2021/2022 season, and accounted for >98% (24,541/24,908 in the South and 20,543/20,634 in the North) of all cases. Influenza virus type B/Yamagata was not detected in all these areas after the COVID-19 pandemic. Several measures individually significantly influence local influenza activity, except for influenza type B in Australia. When combined with all the measures, the deviance explained values for influenza A and B were 87.4% (P<.05 for measures of close public transport and restrictions on international travel) and 77.6% in southern China and 83.4% (P<.05 for measures of school closing and close public transport) and 81.4% in northern China, respectively. In the United States, the association was relatively stronger, with deviance-explained values of 98.6% for influenza A and 99.1% (P<.05 for measures of restrictions on international travel and public information campaign) for influenza B. There were no discernible effects on influenza B activity in Australia between 2020 and 2022 due to the incredibly low positive rate of influenza B. Additionally, the deviance explained values were 95.8% (P<.05 for measures of restrictions on gathering size and restrictions on international travel) for influenza A and 72.7% for influenza B. Conclusions: Influenza activity has increased gradually since 2021. Mitigation measures for COVID-19 showed correlations with influenza activity, mainly driven by the early stage of the pandemic. During late 2021 and 2022, the influence of mitigation management for COVID-19 seemingly decreased gradually, as the activity of influenza increased compared to the 2020/2021 season. %M 39382955 %R 10.2196/47370 %U https://www.i-jmr.org/2024/1/e47370 %U https://doi.org/10.2196/47370 %U http://www.ncbi.nlm.nih.gov/pubmed/39382955 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e44492 %T Shift in Demographic Involvement and Clinical Characteristics of COVID-19 From Wild-Type SARS-CoV-2 to the Delta Variant in the Indian Population: In Silico Analysis %A Kumar,Ashutosh %A Asghar,Adil %A Raza,Khursheed %A Narayan,Ravi K %A Jha,Rakesh K %A Satyam,Abhigyan %A Kumar,Gopichand %A Dwivedi,Prakhar %A Sahni,Chetan %A Kumari,Chiman %A Kulandhasamy,Maheswari %A Motwani,Rohini %A Kaur,Gurjot %A Krishna,Hare %A Kumar,Sujeet %A Sesham,Kishore %A Pandey,Sada N %A Parashar,Rakesh %A Kant,Kamla %+ Department of Microbiology, All India Institute of Medical Sciences-Bathinda, Mandi Dabwali Rd, Bathinda, 151001, India, 91 0164 286 ext 8710, drkamlakant@gmail.com %K SARS-CoV-2 %K COVID-19 %K epidemiology %K demographic shift %K severity of illness %K variant %K virus %K pandemic %K population studies %K genomic analysis %D 2024 %7 8.10.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: The Delta variant (B.1.617.2) was considered the most dangerous SARS-CoV-2 strain; however, in-depth studies on its impact based on demographic and clinical characteristics of COVID-19 are scarce. Objective: We aimed to investigate the shift in demographic and clinical characteristics of the COVID-19 pandemic with the emergence of the SARS-CoV-2 Delta variant compared with the wild-type (WT) strain (B.1). Methods: A cross-sectional study of COVID-19 cases in the Indian population caused by the WT strain (B.1) and Delta variant of SARS-CoV-2 was performed. The viral genomic sequence metadata containing demographic, vaccination, and patient status details (N=9500, NDelta=6238, NWT=3262) were statistically analyzed. Results: With the Delta variant, in comparison with the WT strain, a higher proportion of young individuals (<20 years) were infected (0-9 years: Delta: 281/6238, 4.5% vs B.1: 75/3262, 2.3%; 10-19 years: Delta: 562/6238, 9% vs B.1: 229/3262, 7%; P<.001). The proportion of women contracting infection increased (Delta: 2557/6238, 41% vs B.1: 1174/3262, 36%; P<.001). However, it decreased for men (Delta: 3681/6238, 59% vs B.1: 2088/3262, 64%; P<.001). An increased proportion of the young population developed symptomatic illness and were hospitalized (Delta: 27/262, 10.3% vs B.1: 5/130, 3.8%; P=.02). Moreover, an increased proportion of the women (albeit not men) from the young (Delta: 37/262, 14.1% vs B.1: 4/130, 3.1%; P<.001) and adult (Delta: 197/262, 75.2% vs B.1: 72/130, 55.4%; P<.001) groups developed symptomatic illness and were hospitalized. The mean age of men and women who contracted infection (Delta: men=37.9, SD 17.2 years; women=36.6, SD 17.6 years; P<.001; B.1: men=39.6, SD 16.9 years; women=40.1, SD 17.4 years; P<.001) as well as developing symptoms or being hospitalized (Delta: men=39.6, SD 17.4 years; women=35.6, SD 16.9 years, P<.001; B.1: men=47, SD 18 years; women=49.5, SD 20.9 years, P<.001) were considerably lower with the Delta variant than the B.1 strain. The total mortality was about 1.8 times higher with the Delta variant than with the WT strain. With the Delta variant, compared with B.1, mortality decreased for men (Delta: 58/85, 68% vs B.1: 15/20, 75%; P<.001); in contrast, it increased for women (Delta: 27/85, 32% vs B.1: 5/20, 25%; P<.001). The odds of death increased with age, irrespective of sex (odds ratio 3.034, 95% CI 1.7-5.2, P<.001). Frequent postvaccination infections (24/6238) occurred with the Delta variant following complete doses. Conclusions: The increased involvement of young people and women, the lower mean age for illness, higher mortality, and frequent postvaccination infections were significant epidemiological concerns with the Delta variant. %M 39378428 %R 10.2196/44492 %U https://www.i-jmr.org/2024/1/e44492 %U https://doi.org/10.2196/44492 %U http://www.ncbi.nlm.nih.gov/pubmed/39378428 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e63176 %T Investigating Exposure and Hazards of Micro- and Nanoplastics During Pregnancy and Early Life (AURORA Project): Protocol for an Interdisciplinary Study %A Durkin,Amanda M %A Zou,Runyu %A Boucher,Justin M %A Boyles,Matthew SP %A van Boxel,Jeske %A Bustamante,Mariona %A Christopher,Emily A %A Dadvand,Payam %A Dusza,Hanna M %A van Duursen,Majorie %A Forsberg,Markus M %A Galea,Karen S %A Legler,Juliette %A Mandemaker,Laurens DB %A Meirer,Florian %A Muncke,Jane %A Nawrot,Tim S %A Přibylová,Petra %A Robuck,Anna R %A Saenen,Nelly D %A Scholz-Böttcher,Barbara M %A Shao,Kuanliang %A Vrijheid,Martine %A Walker,Douglas I %A Zimmermann,Lisa %A Zoutendijk,Laura M %A Lenters,Virissa %A Vermeulen,Roel %+ Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 2, Utrecht, 3584 CM, Netherlands, 31 (0)30 253 35 50, r.c.h.vermeulen@uu.nl %K epidemiology %K pregnancy %K toxicology %K microplastics %K placenta %K risk assessment %D 2024 %7 8.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Micro- and nanoplastics (MNPs) are emerging pollutants of concern with ubiquitous presence in global ecosystems. MNPs pose potential implications for human health; however, the health impacts of MNP exposures are not yet understood. Recent evidence suggests that MNPs can cross the placental barrier, underlying the urgent need to understand their impact on reproductive health and development. Objective: The Actionable eUropean ROadmap for early-life health Risk Assessment of micro- and nanoplastics (AURORA) project will investigate MNP exposures and their biological and health effects during pregnancy and early life, which are critical periods due to heightened vulnerability to environmental stressors. The AURORA project will enhance exposure assessment capabilities for measuring MNPs, MNP-associated chemicals, and plastic additives in human tissues, including placenta and blood. Methods: In this interdisciplinary project, we will advance methods for in-depth characterization and scalable chemical analytical strategies, enabling high-resolution and large-scale toxicological, exposure assessment, and epidemiological studies. The AURORA project performs observational studies to investigate determinants and health impacts of MNPs by including 800 mother-child pairs from 2 existing birth cohorts and 110 women of reproductive age from a newly established cohort. This will be complemented by toxicological studies using a tiered-testing approach and epidemiological investigations to evaluate associations between maternal and prenatal MNP exposures and health perturbations, such as placental function, immune-inflammatory responses, oxidative stress, accelerated aging, endocrine disruption, and child growth and development. The ultimate goal of the AURORA project is to create an MNP risk assessment framework and identify the remaining knowledge gaps and priorities needed to comprehensively assess the impact of MNPs on early-life health. Results: In the first 3 years of this 5-year project (2021-2026), progress was made toward all objectives. This includes completion of recruitment and data collection for new and existing cohorts, development of analytical methodological protocols, and initiation of the toxicological tiered assessments. As of September 2024, data analysis is ongoing and results are expected to be published starting in 2025. Conclusions: As plastic pollution increases globally, it is imperative to understand the impact of MNPs on human health, particularly during vulnerable developmental stages such as early life. The contributions of the AURORA project will inform future risk assessment. International Registered Report Identifier (IRRID): DERR1-10.2196/63176 %M 39378424 %R 10.2196/63176 %U https://www.researchprotocols.org/2024/1/e63176 %U https://doi.org/10.2196/63176 %U http://www.ncbi.nlm.nih.gov/pubmed/39378424 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e52735 %T Disclosure Patterns of Opioid Use Disorders in Perinatal Care During the Opioid Epidemic on X From 2019 to 2021: Thematic Analysis %A Wu,Dezhi %A Ng,Minnie %A Gupta,Saborny Sen %A Raynor,Phyllis %A Tao,Youyou %A Ren,Yang %A Hung,Peiyin %A Qiao,Shan %A Zhang,Jiajia %A Fillo,Jennifer %A Li,Xiaoming %A Guille,Constance %A Eichelberger,Kacey %A Olatosi,Bankole %+ Department of Integrated Information Technology, University of South Carolina, 550 Assembly Street, Columbia, SC, 29298, United States, 1 803 777 4691, dezhiwu@cec.sc.edu %K X %K Twitter %K opioid use disorder %K thematic analysis %K pregnancy %K perinatal care %K women and child health %K maternal health %K COVID-19 %K opioid epidemic %D 2024 %7 7.10.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: In 2021, the United States experienced a 14% rise in fatal drug overdoses totaling 106,699 deaths, driven by harmful opioid use, particularly among individuals in the perinatal period who face increased risks associated with opioid use disorders (OUDs). Increased concerns about the impacts of escalating harmful opioid use among pregnant and postpartum persons are rising. Most of the current limited perinatal OUD studies were conducted using traditional methods, such as interviews and randomized controlled trials to understand OUD treatment, risk factors, and associated adverse effects. However, little is known about how social media data, such as X, formerly known as Twitter, can be leveraged to explore and identify broad perinatal OUD trends, disclosure and communication patterns, and public health surveillance about OUD in the perinatal period. Objective: The objective is 3-fold: first, we aim to identify key themes and trends in perinatal OUD discussions on platform X. Second, we explore user engagement patterns, including replying and retweeting behaviors. Third, we investigate computational methods that could potentially streamline and scale the labor-intensive manual annotation effort. Methods: We extracted 6 million raw perinatal-themed tweets posted by global X users during the opioid epidemic from May 2019 to October 2021. After data cleaning and sampling, we used 500 tweets related to OUD in the perinatal period by US X users for a thematic analysis using NVivo (Lumivero) software. Results: Seven major themes emerged from our thematic analysis: (1) political views related to harmful opioid and other substance use, (2) perceptions of others’ substance use, (3) lived experiences of opioid and other substance use, (4) news reports or papers related to opioid and other substance use, (5) health care initiatives, (6) adverse effects on children’s health due to parental substance use, and (7) topics related to nonopioid substance use. Among these 7 themes, our user engagement analysis revealed that themes 4 and 5 received the highest average retweet counts, and theme 3 received the highest average tweet reply count. We further found that different computational methods excel in analyzing different themes. Conclusions: Social media platforms such as X can serve as a valuable tool for analyzing real-time discourse and exploring public perceptions, opinions, and behaviors related to maternal substance use, particularly, harmful opioid use in the perinatal period. More health promotion strategies can be carried out on social media platforms to provide educational support for the OUD perinatal population. %M 39374068 %R 10.2196/52735 %U https://pediatrics.jmir.org/2024/1/e52735 %U https://doi.org/10.2196/52735 %U http://www.ncbi.nlm.nih.gov/pubmed/39374068 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e59274 %T Association Between Ursodeoxycholic Acid and Clinical Outcomes in Patients With COVID-19 Infection: Population-Based Cohort Study %A Lee,Hyunjun %A Kim,Min Gul %A Yeom,Sang Woo %A Noh,Sang Jae %A Jeong,Cho Yun %A Kim,Min Ji %A Kang,Min Gu %A Ko,Ji Hoon %A Park,Su Cheol %A Kweon,Hyeok Tae %A Sim,Sang Il %A Lee,Hyun %A You,Yeon Seok %A Kim,Jong Seung %+ Department of Medical Informatics, Department of Otorhinolaryngology, Jeonbuk National University School of Medicine and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju-si, Jeonbuk-do, Jeonju, 54907, Republic of Korea, 82 +82 63 250 2792, kjsjdk@gmail.com %K Covid 19 %K COVID-19 %K ursodeoxycholic acid %K population-based cohort study %K SARS-CoV-2 %K Coronavirus %K pandemic %K population-based %K retrospective cohort study %K propensity score %K UDCA %K public health %K common data model %K clinical %K severity %D 2024 %7 7.10.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Several studies have investigated the relationship between ursodeoxycholic acid (UDCA) and COVID-19 infection. However, complex and conflicting results have generated confusion in the application of these results. Objective: We aimed to investigate whether the association between UDCA and COVID-19 infection can also be demonstrated through the analysis of a large-scale cohort. Methods: This retrospective study used local and nationwide cohorts, namely, the Jeonbuk National University Hospital into the Observational Medical Outcomes Partnership common data model cohort (JBUH CDM) and the Korean National Health Insurance Service claim–based database (NHIS). We investigated UDCA intake and its relationship with COVID-19 susceptibility and severity using validated propensity score matching. Results: Regarding COVID-19 susceptibility, the adjusted hazard ratio (aHR) value of the UDCA intake was significantly lowered to 0.71 in the case of the JBUH CDM (95% CI 0.52-0.98) and was significantly lowered to 0.93 (95% CI 0.90-0.96) in the case of the NHIS. Regarding COVID-19 severity, the UDCA intake was found to be significantly lowered to 0.21 (95% CI 0.09-0.46) in the case of JBUH CDM. Furthermore, the aHR value was significantly lowered to 0.77 in the case of NHIS (95% CI 0.62-0.95). Conclusions: Using a large-scale local and nationwide cohort, we confirmed that UDCA intake was significantly associated with reductions in COVID-19 susceptibility and severity. These trends remained consistent regardless of the UDCA dosage. This suggests the potential of UDCA as a preventive and therapeutic agent for COVID-19 infection. %M 39139026 %R 10.2196/59274 %U https://publichealth.jmir.org/2024/1/e59274 %U https://doi.org/10.2196/59274 %U http://www.ncbi.nlm.nih.gov/pubmed/39139026 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e51563 %T Unlocking the Potential of Secondary Data for Public Health Research: Retrospective Study With a Novel Clinical Platform %A Gundler,Christopher %A Gottfried,Karl %A Wiederhold,Alexander Johannes %A Ataian,Maximilian %A Wurlitzer,Marcus %A Gewehr,Jan Erik %A Ückert,Frank %+ Institute for Applied Medical Informatics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany, 49 40741054979, c.gundler@uke.de %K secondary use %K hypothesis testing %K research platform %K clinical data %K Parkinson disease %K data %K health-related research %K health data %K electronic health record %K EHR %K tremor %D 2024 %7 1.10.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Clinical routine data derived from university hospitals hold immense value for health-related research on large cohorts. However, using secondary data for hypothesis testing necessitates adherence to scientific, legal (such as the General Data Protection Regulation, federal and state protection legislations), technical, and administrative requirements. This process is intricate, time-consuming, and susceptible to errors. Objective: This study aims to develop a platform that enables clinicians to use current real-world data for testing research and evaluate advantages and limitations at a large university medical center (542,944 patients in 2022). Methods: We identified requirements from clinical practitioners, conceptualized and implemented a platform based on the existing components, and assessed its applicability in clinical reality quantitatively and qualitatively. Results: The proposed platform was established at the University Medical Center Hamburg-Eppendorf and made 639 forms encompassing 10,629 data elements accessible to all resident scientists and clinicians. Every day, the number of patients rises, and parts of their electronic health records are made accessible through the platform. Qualitatively, we were able to conduct a retrospective analysis of Parkinson disease over 777 patients, where we provide additional evidence for a significantly higher proportion of action tremors in patients with rest tremors (340/777, 43.8%) compared with those without rest tremors (255/777, 32.8%), as determined by a chi-square test (P<.001). Quantitatively, our findings demonstrate increased user engagement within the last 90 days, underscoring clinicians’ increasing adoption of the platform in their regular research activities. Notably, the platform facilitated the retrieval of clinical data from 600,000 patients, emphasizing its substantial added value. Conclusions: This study demonstrates the feasibility of simplifying the use of clinical data to enhance exploration and sustainability in scientific research. The proposed platform emerges as a potential technological and legal framework for other medical centers, providing them with the means to unlock untapped potential within their routine data. %M 39353185 %R 10.2196/51563 %U https://www.i-jmr.org/2024/1/e51563 %U https://doi.org/10.2196/51563 %U http://www.ncbi.nlm.nih.gov/pubmed/39353185 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48794 %T Mobile Phones and HIV Testing: Multicountry Instrumental Variable Analysis From Sub-Saharan Africa %A Iacoella,Francesco %A Tirivayi,Nyasha %+ UNICEF Evaluation Office, 3 United Nations Plaza, New York, NY, 10017, United States, 1 9296459846, iacoella@merit.unu.edu %K information and knowledge %K communication %K health and economic development %K public health %K technological change %K choices and consequences %K mobile phone %K connectivity %K access %K HIV %K testing %K Sub-Saharan Africa %K women’s health %D 2024 %7 27.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Sub-Saharan Africa has been a technological hothouse when it comes to mobile phone technology adoption. However, evidence on the role played by mobile technology on infectious disease prevention has been mostly limited to experimental studies. Objective: This observational study investigates the role of mobile phone connectivity on HIV testing in sub-Saharan Africa. Methods: We make use of the novel and comprehensive OpenCelliD cell tower database and Demographic and Health Survey geocoded information for over 400,000 women in 29 sub-Saharan African countries. We examine, through ordinary least square and instrumental variable regressions, whether women’s community distance from the closest cell tower influences knowledge about HIV testing facilities and the likelihood of ever being tested for HIV. Results: After finding a negative and significant impact of distance to the nearest cell tower on knowledge of HIV testing facility (–0.7 percentage points per unit increase in distance) and HIV testing (–0.5 percentage points per unit increase), we investigate the mechanisms through which such effects might occur. Our analysis shows that distance to a cell tower reduces HIV-related knowledge (–0.4 percentage points per unit increase) as well as reproductive health knowledge (–0.4 percentage points per unit increase). Similar results are observed when the analysis is performed at community level. Conclusions: Results suggest that the effect of mobile phone connectivity is channeled through increased knowledge of HIV, sexually transmittable infections, and modern contraceptive methods. Further analysis shows that cell phone ownership has an even larger impact on HIV testing and knowledge. This paper adds to the recent literature on the impact of mobile-based HIV prevention schemes by showing through large-scale analysis that better mobile network access is a powerful tool to spread reproductive health knowledge and increase HIV awareness. %M 39331953 %R 10.2196/48794 %U https://www.jmir.org/2024/1/e48794 %U https://doi.org/10.2196/48794 %U http://www.ncbi.nlm.nih.gov/pubmed/39331953 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e63193 %T Association Between Cigarette and Bidi Purchase Behavior (Loose vs Pack) and Health Warning Label Exposure: Findings From the Tobacco Control Policy India Survey and In-Depth Interviews With People Who Smoke %A Sakhuja,Mayank %A Friedman,Daniela B %A Macauda,Mark M %A Hebert,James R %A Pednekar,Mangesh S %A Gupta,Prakash C %A Fong,Geoffrey T %A Thrasher,James F %+ UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 323A Rosenau Hall CB #7440, Chapel Hill, NC, 27599, United States, 1 8034468063, msakhuja@unc.edu %K loose cigarettes %K singles %K health warning labels %K tobacco control %K India %K mixed methods %K purchase behavior %K tobacco users %K cigarette %K qualitative research %K thematic analysis %K prevention %K health promotion %K public health %D 2024 %7 25.9.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The sale of loose cigarettes or bidis can undermine the purpose of requiring health warning labels (HWLs) on cigarette packs and bidi bundles by diminishing their visibility and legibility. Objective: This mixed-methods study aims to examine the association between purchase behavior (loose vs pack or bundle), HWL exposure, and responses to HWLs among Indian adults who smoke. Methods: Data were analyzed from the 2018-2019 India Tobacco Control Policy Survey and from 28 in-depth interviews conducted with Indian adults who smoked in 2022. The Tobacco Control Policy Survey sample included tobacco users who bought cigarettes (n=643) or bidis (n=730), either loose or in packs or bundles at their last purchase. Ordinal regression models were fit separately for cigarettes and bidis, whereby HWL variables (noticing HWLs, reading and looking closely at HWLs, forgoing a cigarette or bidi because of HWLs, thinking about health risks of smoking, and thinking about quitting smoking cigarettes or bidis because of HWLs) were regressed on last purchase (loose vs packs or bundles). In-depth interviews with participants from Delhi and Mumbai who purchased loose cigarettes in the last month were conducted, and thematic analysis was used to analyze the interview data. Results: Survey findings indicated that about 74.3% (478/643) of cigarette users and 11.8% (86/730) of bidi users reported having bought loose sticks at their last purchase. Those who purchased loose cigarettes (vs packs) noticed HWLs less often (estimate –0.830, 95% CI –1.197 to –0.463, P<.001), whereas those who purchased loose bidis (vs bundles) read and looked closely at HWLs (estimate 0.646, 95% CI 0.013-1.279, P=.046), thought about the harms of bidi smoking (estimate 1.200, 95% CI 0.597-1.802, P<.001), and thought about quitting bidi smoking (estimate 0.871, 95% CI 0.282-1.461, P=.004) more often. Interview findings indicated lower exposure to HWLs among those who purchased loose cigarettes, primarily due to vendors distributing loose cigarettes without showing the original cigarette pack, storing them in separate containers, and consumers’ preference for foreign-made cigarette brands, which often lack HWLs. While participants were generally aware of the contents of HWLs, many deliberately avoided them when purchasing loose cigarettes. In addition, they believed that loose cigarette purchases reduced the HWLs’ potential to deliver consistent reminders about the harmful effects of cigarette smoking due to reduced exposure, an effect more common among those who purchased packs. Participants also noted that vendors, especially small ones, did not display statutory health warnings at their point of sale, further limiting exposure to warning messages. Conclusions: Survey and interview findings indicated that those who purchased loose cigarettes noticed HWLs less often. Loose purchases likely decrease the frequency of exposure to HWLs’ reminders about the harmful effects of smoking, potentially reducing the effectiveness of HWLs. %M 39320944 %R 10.2196/63193 %U https://publichealth.jmir.org/2024/1/e63193 %U https://doi.org/10.2196/63193 %U http://www.ncbi.nlm.nih.gov/pubmed/39320944 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e56059 %T The Effect of Long-Term Particulate Matter Exposure on Respiratory Mortality: Cohort Study in China %A Wang,Ying %A Wang,Zhuohao %A Jiang,Jie %A Guo,Tong %A Chen,Shimin %A Li,Zhiqiang %A Yuan,Zhupei %A Lin,Qiaoxuan %A Du,Zhicheng %A Wei,Jing %A Hao,Yuantao %A Zhang,Wangjian %K respiratory disease %K mortality %K particulate matter %K causal inference %K cohort study %D 2024 %7 24.9.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Particulate matter (PM), which affects respiratory health, has been well documented; however, substantial evidence from large cohorts is still limited, particularly in highly polluted countries and for PM1. Objective: Our objective was to examine the potential causal links between long-term exposure to PMs (PM2.5, PM10, and more importantly, PM1) and respiratory mortality. Methods: A total of 580,757 participants from the Guangzhou area, China, were recruited from 2009 to 2015 and followed up through 2020. The annual average concentrations of PMs at a 1-km spatial resolution around the residential addresses were estimated using validated spatiotemporal models. The marginal structural Cox model was used to estimate the associations of PM exposure with respiratory mortality, accounting for time-varying PM exposure. Results were stratified by demographics and lifestyle behaviors factors. Results: Among the participants, the mean age was 48.33 (SD 17.55) years, and 275,676 (47.47%) of them were men. During the follow-up period, 7260 deaths occurred due to respiratory diseases. The annual average concentrations of PM1, PM2.5, and PM10 showed a declining trend during the follow-up period. After adjusting for confounders, a 6.6% (95% CI 5.6%‐7.6%), 4.2% (95% CI 3.6%‐4.7%), and 4.0% (95% CI 3.6%‐4.5%) increase in the risk of respiratory mortality was observed following each 1-μg/m3 increase in concentrations of PM1, PM2.5, and PM10, respectively. In addition, older participants, nonsmokers, participants with higher exercise frequency, and those exposed to a lower normalized difference vegetation index tended to be more susceptible to the effects of PMs. Furthermore, participants in the low-exposure group tended to be at a 7.6% and 2.7% greater risk of respiratory mortality following PM1 and PM10 exposure, respectively, compared to the entire cohort. Conclusions: This cohort study provides causal clues of the respiratory impact of long-term ambient PM exposure, indicating that PM reduction efforts may continuously benefit the population’s respiratory health. %R 10.2196/56059 %U https://publichealth.jmir.org/2024/1/e56059 %U https://doi.org/10.2196/56059 %0 Journal Article %@ 2373-6658 %I JMIR Publications %V 8 %N %P e60104 %T Current Evidence of the Application of Music in Tai Chi Exercise: Scoping Review %A Du,Yan %A Wei,Gao-Xia %A He,Yichao %A Ning,Hongting %A Roberts,Penny %A Golob,Edward %A Yin,Zenong %+ School of Nursing, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, United States, 1 2105672170, duy@uthscsa.edu %K Tai Chi %K exercise %K music %K synergetic effects %K review %K scoping review %K thematic analysis %K health outcome %K motivation %K performance %K dissemination %K implementation %K public health %K data extraction %D 2024 %7 19.9.2024 %9 Review %J Asian Pac Isl Nurs J %G English %X Background: Music has frequently been used in movement exercises to enhance health benefits. However, scientific evidence regarding the application of music to Tai Chi practice is limited. Objective: This scoping review aims to understand how music has been used in Tai Chi practice and whether music could be applied to Tai Chi practice to help optimize its benefits. Methods: PubMed, CINAHL, CNKI, and Weipu databases were searched. We included studies that compare Tai Chi practice experience or health outcomes between individuals practicing Tai Chi with music and those practicing Tai Chi without music. Studies published through September 2022 were identified. Two researchers (YD and YH) independently performed study selection and data extraction. Thematic analysis was used to summarize and categorize the findings of the included studies. Results: Seven studies were included in this review. All 7 included studies are experimental studies. Practicing Tai Chi with music might lead to positive perceptions of Tai Chi practice (eg, motivation, concentration, enjoyment, compliance, and performance) and higher evaluations of Tai Chi instructional quality, especially for Tai Chi beginners. The effects of incorporating music into Tai Chi practice on health outcomes are inconclusive due to the heterogeneities of the sample size, and the intervention components, lengths, and frequencies of the included studies. Conclusions: Applying music to Tai Chi practice may result in positive Tai Chi practice experience and adherence, particularly for beginners, which could help improve the dissemination and implementation of Tai Chi interventions for public health. However, whether applying music to Tai Chi practice leads to synergetic effects on health outcomes needs further investigation. %M 39298259 %R 10.2196/60104 %U https://apinj.jmir.org/2024/1/e60104 %U https://doi.org/10.2196/60104 %U http://www.ncbi.nlm.nih.gov/pubmed/39298259 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60277 %T Peer Intervention to Link Overdose Survivors to Treatment (PILOT): Protocol for a Multisite, Randomized Controlled Trial Conducted Within the National Institute on Drug Abuse Clinical Trials Network %A Papa,Carrie %A McClure,Erin A %A McCauley,Jenna %A Haynes,Louise %A Matheson,Timothy %A Jones,Richard %A Jennings,Lindsey %A Lawdahl,Tricia %A Ward,Ralph %A Brady,Kathleen %A Barth,Kelly Stephenson %+ Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States, 1 843 876 1507, papa@musc.edu %K opioids %K overdose %K nonfatal overdose involving opioids %K peer support specialist %K harm reduction %K emergency department %D 2024 %7 17.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The increase in opioid-related overdoses has caused a decrease in average life expectancy, highlighting the need for effective interventions to reduce overdose risk and prevent subsequent overdoses. Peer support specialists (PSSs) offer an appealing strategy to engage overdose survivors and reduce overdose risk, but randomized controlled trials are needed to formalize peer-led interventions and evaluate their effectiveness. Objective: This National Institute on Drug Abuse Clinical Trials Network (CTN) study is a multisite, prospective, pilot randomized (1:1) controlled trial (CTN protocol 0107) that aims to evaluate the effectiveness of an emergency department (ED)–initiated, peer-delivered intervention tailored for opioid overdose survivors (Peer Intervention to Link Overdose survivors to Treatment [PILOT]), compared with treatment as usual (TAU). Methods: This study evaluates the effectiveness of the 6-month, PSS-led PILOT intervention compared with TAU on the primary outcome of reducing overdose risk behavior 6 months after enrollment. Adults (aged ≥18 years; N=150) with a recent opioid-related overdose were identified and approached in the ED. Participants were screened and enrolled, either in the ED or within 7 days of ED discharge at research offices or in the community and then asked to complete study visits at months 1, 3, 6 (end of intervention), and 7 (follow-up). Participants were enrolled at 3 study sites in the United States: Greenville, South Carolina; Youngstown, Ohio; and Everett, Washington. Participants randomized to the PILOT intervention received a 6-month, PSS-led intervention tailored to each participant’s goals to reduce their overdose risk behavior (eg, overdose harm reduction, housing, medical, and substance use treatment or recovery goals). Participants randomized to TAU received standard-of-care overdose materials, education, and services provided through the participating EDs. This paper describes the study protocol and procedures, explains the design and inclusion and exclusion decisions, and provides details of the peer-led PILOT intervention and supervision of PILOT PSSs. Results: Study enrollment opened in December 2021 and was closed in July 2023. A total of 150 participants across 3 sites were enrolled in the study, meeting the proposed sample size for the trial. Primary and secondary analyses are underway and expected to be published in early 2025. Conclusions: There is an urgent need to better understand the characteristics of overdose survivors presenting to the ED and for rigorous trials evaluating the effectiveness of PSS-led interventions on engaging overdose survivors and reducing overdose risk. Results from this pilot randomized controlled trial will provide a description of the characteristics of overdose survivors presenting to the ED; outline the implementation of PSS services research in ED settings, including PSS implementation of PSS supervision and activity tracking; and inform ED-initiated PSS-led overdose risk reduction interventions and future research to better understand the implementation and efficacy of these interventions. Trial Registration: ClinicalTrials.gov NCT05123027; https://clinicaltrials.gov/study/NCT05123027 International Registered Report Identifier (IRRID): DERR1-10.2196/60277 %M 39288373 %R 10.2196/60277 %U https://www.researchprotocols.org/2024/1/e60277 %U https://doi.org/10.2196/60277 %U http://www.ncbi.nlm.nih.gov/pubmed/39288373 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e62765 %T Rethinking the Social Determination of Food in Chile Through Practices and Interactions of Actors in Food Environments: Nonexperimental, Cross-Sectional Study %A Gálvez Espinoza,Patricia %A Rodríguez Osiac,Lorena %A Franch Maggiolo,Carolina %A Egaña Rojas,Daniel %+ Department of Primary Care and Family Health, Universidad de Chile, Avenida José Miguel Carrera 3100, San Miguel, Santiago, 8320000, Chile, 56 997579767, degana@uchile.cl %K mixed methods %K research design %K food environments %K food intake %K obesity %D 2024 %7 13.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Food environments are crucial for promoting healthy and sustainable eating and preventing obesity. However, existing food environment frameworks assume an already installed causality and do not explain how associations in food environments are established or articulated, especially from an integrative and transdisciplinary approach. This research attempts to bridge these gaps through the use of Actor-Network Theory, which traces the relationship network between human (and nonhuman) actors in order to describe how these interact and what agencies (direct or remote) are involved. Objective: This study aims to explain the practices and interactions of actors in food environments in order to approach the problem of unhealthy eating with a transdisciplinary approach. Methods: This is a nonexperimental, cross-sectional study. Due to the complexity of the study phenomena, a mixed methods approach with 4 consecutive phases will be developed in Chile. Phase 1 involves a systematic literature review of food environment evidence since 2015, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol; phase 2 involves the application of a shortened version of the Nutrition Environment Measure Scale—Perceptions adapted to Chile (NEMS-P-Ch) in 2 neighborhoods with different socioeconomic levels; in phase 3, six focus groups in each neighborhood will be conducted to address social determinants such as gender, employment status, and migration; and in phase 4, participant observation and in-depth interviews will be used to analyze the direct and empirical exploration of the actors in their daily interaction with food environments. The triangulation and complementarity of the data will allow us to create a practical model about the practices and interactions of actors in their food environments, which reflects the complexity and transdisciplinary nature of the study. Results: We have advanced in phases 1-3 of the study. In phase 1, a total of 109 manuscripts are being revised for data extraction. In phase 2, we applied the NEMS-P-Ch to 785 people, 49.4% (388/785) of whom belong to a low socioeconomic neighborhood. Participants from phase 2 are being contacted to participate in the focus groups (phase 3). By the end of July, we have conducted 6 focus groups with 5-11 participants. Conclusions: This study will provide a comprehensive understanding of how individuals interact with their food environments, offering deep insights into the factors influencing their food-related decisions. In addition, the study aims to develop a model that more accurately reflects reality by examining not only the food environments themselves but also the interactions among various stakeholders within these environments and their daily practices. The findings of this study will offer evidence-based insights to inform public policies tailored to the specific territories and communities under investigation or those with similar characteristics. International Registered Report Identifier (IRRID): DERR1-10.2196/62765 %M 39270213 %R 10.2196/62765 %U https://www.researchprotocols.org/2024/1/e62765 %U https://doi.org/10.2196/62765 %U http://www.ncbi.nlm.nih.gov/pubmed/39270213 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57343 %T Community Health Workers as Mental Health Paraprofessionals: Protocol for a Mixed-Methods Pilot Feasibility Study %A Moyce,Sally %A Crawford,Cassidy %+ College of Health and Human Development, Montana State University, PO Box 173560, Bozeman, MT, 59717, United States, 1 970 846 8424, cassacrawford8@gmail.com %K behavioral activation %K community health workers %K implementation science %K Latino %K mental health provider shortage area %K pilot study %K evidence-based treatments %D 2024 %7 12.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Community health workers (CHWs) are effective in delivering behavioral activation (BA), especially in low-resource settings. In an area with a lack of Spanish-speaking mental health counselors, such as southwest Montana, CHWs can provide needed care. Objective: The goal of this pilot study protocol is to test the feasibility, acceptability, and preliminary efficacy of a model of care that engages CHWs as providers of BA. Methods: We will train 2 CHWs in BA methodology. We will enroll 20 participants who screen positive for depression in a 12-week telephone intervention for BA. Preliminary efficacy will be tested in pre- and postscores of the Beck Depression Inventory and semistructured interviews. Feasibility and acceptability will be measured through participant retention and treatment adherence. The Therapeutic Alliance with Clinician Scale will be used to measure the strength of the therapeutic relationship. Descriptive statistics will measure alliances and repeated measures ANOVA will measure trends and changes in depression scores. Results: Enrollment began in October 2023. A total of 12 participants completed at least 10 BA sessions and all study measures by the time the study concluded in May 2024. In August 2024, data analysis occurred with an anticipated manuscript to be submitted for publication in October 2024. Conclusions: Results from this study will inform future studies into the implementation of an evidence-based mental health intervention in a limited resource setting for Latino people with limited English proficiency. International Registered Report Identifier (IRRID): DERR1-10.2196/57343 %M 39264699 %R 10.2196/57343 %U https://www.researchprotocols.org/2024/1/e57343 %U https://doi.org/10.2196/57343 %U http://www.ncbi.nlm.nih.gov/pubmed/39264699 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54269 %T Developing and Evaluating Digital Public Health Interventions Using the Digital Public Health Framework DigiPHrame: A Framework Development Study %A Jahnel,Tina %A Pan,Chen-Chia %A Pedros Barnils,Núria %A Muellmann,Saskia %A Freye,Merle %A Dassow,Hans-Henrik %A Lange,Oliver %A Reinschluessel,Anke V %A Rogowski,Wolf %A Gerhardus,Ansgar %+ Department of Health Services Research, Institute for Public Health and Nursing Research, University of Bremen, Grazer Str 4, Bremen, 28359, Germany, 49 042121868808, jahnel@uni-bremen.de %K digital public health %K DiPH %K digital health %K public health %K framework %K development %K evaluation %K guidance %K program evaluation %K telemedicine %K intervention %K technological advancement %K opportunity %K technology %K implementation %K digital public health framework %K DigiPHrame %K scoping review %K COVID-19 %K contact-tracing app %K contact tracing %D 2024 %7 12.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital public health (DiPH) interventions may help us tackle substantial public health challenges and reach historically underserved populations, in addition to presenting valuable opportunities to improve and complement existing services. However, DiPH interventions are often triggered through technological advancements and opportunities rather than public health needs. To develop and evaluate interventions designed to serve public health needs, a comprehensive framework is needed that systematically covers all aspects with relevance for public health. This includes considering the complexity of the technology, the context in which the technology is supposed to operate, its implementation, and its effects on public health, including ethical, legal, and social aspects. Objective: We aimed to develop such a DiPH framework with a comprehensive list of core principles to be considered throughout the development and evaluation process of any DiPH intervention. Methods: The resulting digital public health framework (DigiPHrame) was based on a scoping review of existing digital health and public health frameworks. After extracting all assessment criteria from these frameworks, we clustered the criteria. During a series of multidisciplinary meetings with experts from the Leibniz ScienceCampus Digital Public Health, we restructured each domain to represent the complexity of DiPH. In this paper, we used a COVID-19 contact–tracing app as a use case to illustrate how DigiPHrame may be applied to assess DiPH interventions. Results: The current version of DigiPHrame consists of 182 questions nested under 12 domains. Domain 1 describes the current status of health needs and existing interventions; domains 2 and 3, the DiPH technology under assessment and aspects related to human-computer interaction, respectively; domains 4 and 5, structural and process aspects, respectively; and domains 6-12, contextual conditions and the outcomes of the DiPH intervention from broad perspectives. In the CWA use case, a number of questions relevant during its development but also important for assessors once the CWA was available were highlighted. Conclusions: DigiPHrame is a comprehensive framework for the development and assessment of digital technologies designed for public health purposes. It is a living framework and will, therefore, be updated regularly and as new public health needs and technological advancements emerge. %M 39264696 %R 10.2196/54269 %U https://www.jmir.org/2024/1/e54269 %U https://doi.org/10.2196/54269 %U http://www.ncbi.nlm.nih.gov/pubmed/39264696 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e45689 %T Health and Well-Being Among College Students in the United States During the COVID-19 Pandemic: Daily Diary Study %A Lanza,Stephanie T %A Whetzel,Courtney %A Bhandari,Sandesh %+ Department of Biobehavioral Health, The Pennsylvania State University, 302 Biobehavioral Health Building, University Park, PA, 16802, United States, 1 814 865 7095, SLanza@psu.edu %K daily diary %K college student %K young adult %K mental health %K substance use %K stress %K well-being %K belonging %D 2024 %7 23.8.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: There is evidence that anxiety and stress increased among college students during the COVID-19 pandemic. However, less is known about daily experiences of affect, worry, substance use behaviors, experiences of pleasure, concern over food security, experiences of bias or discrimination, feelings of belongingness, and other indicators of well-being and how they vary across days in this population. Objective: This study surveyed a wide range of indicators of health and well-being in daily life over 21 days with a sample of college students in a large university system in the United States during the pandemic. The overall variance in each daily measure was partitioned to reflect the proportion due to (1) between-person differences versus (2) within-person, day-to-day variability. This is important because measures that vary primarily due to between-person differences may be more amenable to interventions that target particular students, whereas measures that vary more due to day-to-day variability may be more amenable to interventions that target day-level contextual factors. Methods: A sample of 2068 young adult college students (aged 18-24, mean 19.8, SD 1.3 years; 66.6% women) completed a baseline survey; 97.3% (n=2012) then completed up to 21 consecutive daily surveys that assessed a comprehensive set of daily markers of health, behavior, and well-being. The daily diary study produced a total of 33,722 person-days. Results: Among all person-days, a minority were substance use days (eg, 14.5% of days involved alcohol use, 5.6% vaping, and 5.5% cannabis). Experiences of pleasure were reported on most (73.5%) days. Between-person differences explained more than 50% of the variance in numerous indicators of health and well-being, including daily vaping, cannabis use, other illicit substance use, experiences of bias or discrimination, positive affect, negative affect, worry, food insecurity, and feelings of belonging at the university. In contrast, within-person differences explained more than 50% of the variance in daily alcohol use, cigarette use, stress, experiences of pleasure, where the student slept last night, and physical activity. Conclusions: College student health and well-being are multifaceted, with some aspects likely driven by person-level characteristics and experiences and other aspects by more dynamic, contextual risk factors that occur in daily life. These findings implicate services and interventions that should target individual students versus those that should target days on which students are at high risk for poor experiences or behaviors. %M 39178037 %R 10.2196/45689 %U https://www.i-jmr.org/2024/1/e45689 %U https://doi.org/10.2196/45689 %U http://www.ncbi.nlm.nih.gov/pubmed/39178037 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e48594 %T Reforming China’s Secondary Vocational Medical Education: Adapting to the Challenges and Opportunities of the AI Era %A Tong,Wenting %A Zhang,Xiaowen %A Zeng,Haiping %A Pan,Jianping %A Gong,Chao %A Zhang,Hui %K secondary vocational medical education %K artificial intelligence %K practical skills %K critical thinking %K AI %D 2024 %7 15.8.2024 %9 %J JMIR Med Educ %G English %X China’s secondary vocational medical education is essential for training primary health care personnel and enhancing public health responses. This education system currently faces challenges, primarily due to its emphasis on knowledge acquisition that overshadows the development and application of skills, especially in the context of emerging artificial intelligence (AI) technologies. This article delves into the impact of AI on medical practices and uses this analysis to suggest reforms for the vocational medical education system in China. AI is found to significantly enhance diagnostic capabilities, therapeutic decision-making, and patient management. However, it also brings about concerns such as potential job losses and necessitates the adaptation of medical professionals to new technologies. Proposed reforms include a greater focus on critical thinking, hands-on experiences, skill development, medical ethics, and integrating humanities and AI into the curriculum. These reforms require ongoing evaluation and sustained research to effectively prepare medical students for future challenges in the field. %R 10.2196/48594 %U https://mededu.jmir.org/2024/1/e48594 %U https://doi.org/10.2196/48594 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e56061 %T Sociodigital Determinants of eHealth Literacy and Related Impact on Health Outcomes and eHealth Use in Korean Older Adults: Community-Based Cross-Sectional Survey %A Kyaw,Myat Yadana %A Aung,Myo Nyein %A Koyanagi,Yuka %A Moolphate,Saiyud %A Aung,Thin Nyein Nyein %A Ma,Hok Ka Carol %A Lee,Hocheol %A Nam,Hae-Kweun %A Nam,Eun Woo %A Yuasa,Motoyuki %K eHealth literacy %K eHEALS %K electronic health information %K eHealth information %K health literacy %K health education %K eHealth education %K health training %K eHealth training %K digital health %K digital technology %K digital intervention %K digital interventions %K gray digital divide %K healthy aging %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K older person %K older people %K aging %K aging %K eHealth Literacy Scale %D 2024 %7 13.8.2024 %9 %J JMIR Aging %G English %X Background: eHealth literacy is an essential skill for pursuing electronic health information, particularly for older people whose health needs increase with age. South Korea is now at the intersection of a rapidly digitalizing society and an increasingly aged population. eHealth literacy enables older people to maximize the effective use of emerging digital technology for their health and quality of life. Understanding the eHealth literacy of Korean older adults is critical to eliminating the gray digital divide and inequity in health information access. Objective: This study aims to investigate factors influencing eHealth literacy in older Korean adults and its impact on health outcomes and eHealth use. Methods: This was a cross-sectional survey. Community-dwelling older adults 65 years and older in 2 urban cities in South Korea were included. eHealth literacy was measured by the eHealth Literacy Scale. Ordinal logistic regression was used to analyze factors associated with eHealth literacy and multivariate ANOVA for the impact of eHealth literacy on health outcomes and eHealth use. Results: In total, 434 participants were analyzed. A total of 22.3% (97/434) of participants had high eHealth literacy skills. Increasing age, higher monthly income, and time spent on the internet were significantly associated with eHealth literacy (P<.001), and social media users were 3.97 times (adjusted odds ratio 3.97, 95% CI 1.02‐15.43; P=.04) more likely to have higher skill. Higher eHealth literacy was associated with better self-perceived health and frequent use of digital technologies for accessing health and care services (P<.001). Conclusions: Disparity in socioeconomic status and engagement on the internet and social media can result in different levels of eHealth literacy skills, which can have consequential impacts on health outcomes and eHealth use. Tailored eHealth interventions, grounded on the social and digital determinants of eHealth literacy, could facilitate eHealth information access among older adults and foster a digitally inclusive healthy aging community. %R 10.2196/56061 %U https://aging.jmir.org/2024/1/e56061 %U https://doi.org/10.2196/56061 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e54687 %T Resilience Informatics: Role of Informatics in Enabling and Promoting Public Health Resilience to Pandemics, Climate Change, and Other Stressors %A Iyengar,M Sriram %A Block Ngaybe,Maiya G %A Gonzalez,Myla %A Arora,Mona %+ University of Arizona College of Medicine, 475 North 5th Street, E967C, Phoenix, AZ, 85004, United States, 1 2817934733, msiyengar@arizona.edu %K health informatics %K data science %K climate change %K pandemics %K COVID-19 %K migrations %K mobile phone %D 2024 %7 12.8.2024 %9 Viewpoint %J Interact J Med Res %G English %X Climate change, local epidemics, future pandemics, and forced displacements pose significant public health threats worldwide. To cope successfully, people and communities are faced with the challenging task of developing resilience to these stressors. Our viewpoint is that the powerful capabilities of modern informatics technologies including artificial intelligence, biomedical and environmental sensors, augmented or virtual reality, data science, and other digital hardware or software, have great potential to promote, sustain, and support resilience in people and communities. However, there is no “one size fits all” solution for resilience. Solutions must match the specific effects of the stressor, cultural dimensions, social determinants of health, technology infrastructure, and many other factors. %M 39133540 %R 10.2196/54687 %U https://www.i-jmr.org/2024/1/e54687 %U https://doi.org/10.2196/54687 %U http://www.ncbi.nlm.nih.gov/pubmed/39133540 %0 Journal Article %@ 2369-2960 %I %V 10 %N %P e51883 %T Impact of Ambient Temperature on Mortality Burden and Spatial Heterogeneity in 16 Prefecture-Level Cities of a Low-Latitude Plateau Area in Yunnan Province: Time-Series Study %A Chen,Yang %A Zhou,Lidan %A Zha,Yuanyi %A Wang,Yujin %A Wang,Kai %A Lu,Lvliang %A Guo,Pi %A Zhang,Qingying %K mortality burden %K nonaccidental deaths %K multivariate meta-analysis %K distributed lagged nonlinear mode %K attributable risk %K climate change %K human health %K association %K temperature %K mortality %K nonaccidental death %K spatial heterogeneity %K meteorological data %K temperature esposure %K heterogeneous %K spatial planning %K environmental temperature %K prefecture-level %K resource allocation %D 2024 %7 23.7.2024 %9 %J JMIR Public Health Surveill %G English %X Background: The relation between climate change and human health has become one of the major worldwide public health issues. However, the evidence for low-latitude plateau regions is limited, where the climate is unique and diverse with a complex geography and topography. Objectives: This study aimed to evaluate the effect of ambient temperature on the mortality burden of nonaccidental deaths in Yunnan Province and to further explore its spatial heterogeneity among different regions. Methods: We collected mortality and meteorological data from all 129 counties in Yunnan Province from 2014 to 2020, and 16 prefecture-level cities were analyzed as units. A distributed lagged nonlinear model was used to estimate the effect of temperature exposure on years of life lost (YLL) for nonaccidental deaths in each prefecture-level city. The attributable fraction of YLL due to ambient temperature was calculated. A multivariate meta-analysis was used to obtain an overall aggregated estimate of effects, and spatial heterogeneity among 16 prefecture-level cities was evaluated by adjusting the city-specific geographical characteristics, demographic characteristics, economic factors, and health resources factors. Results: The temperature-YLL association was nonlinear and followed slide-shaped curves in all regions. The cumulative cold and heat effect estimates along lag 0‐21 days on YLL for nonaccidental deaths were 403.16 (95% empirical confidence interval [eCI] 148.14‐615.18) and 247.83 (95% eCI 45.73‐418.85), respectively. The attributable fraction for nonaccidental mortality due to daily mean temperature was 7.45% (95% eCI 3.73%‐10.38%). Cold temperature was responsible for most of the mortality burden (4.61%, 95% eCI 1.70‐7.04), whereas the burden due to heat was 2.84% (95% eCI 0.58‐4.83). The vulnerable subpopulations include male individuals, people aged <75 years, people with education below junior college level, farmers, nonmarried individuals, and ethnic minorities. In the cause-specific subgroup analysis, the total attributable fraction (%) for mean temperature was 13.97% (95% eCI 6.70‐14.02) for heart disease, 11.12% (95% eCI 2.52‐16.82) for respiratory disease, 10.85% (95% eCI 6.70‐14.02) for cardiovascular disease, and 10.13% (95% eCI 6.03‐13.18) for stroke. The attributable risk of cold effect for cardiovascular disease was higher than that for respiratory disease cause of death (9.71% vs 4.54%). Furthermore, we found 48.2% heterogeneity in the effect of mean temperature on YLL after considering the inherent characteristics of the 16 prefecture-level cities, with urbanization rate accounting for the highest proportion of heterogeneity (15.7%) among urban characteristics. Conclusions: This study suggests that the cold effect dominated the total effect of temperature on mortality burden in Yunnan Province, and its effect was heterogeneous among different regions, which provides a basis for spatial planning and health policy formulation for disease prevention. %R 10.2196/51883 %U https://publichealth.jmir.org/2024/1/e51883 %U https://doi.org/10.2196/51883 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48434 %T The Impact of COVID-19 Health Measures on Adults With Multiple Chemical Sensitivity: Cross-Sectional Study %A Bray,Riina %A Wang,Yifan %A Argiropoulos,Nikolas %A Robins,Stephanie %A Molot,John %A Pigeon,Marie-Andrée %A Gaudet,Michel %A Auger,Pierre %A Bélanger,Emilie %A Peris,Rohini %+ Association pour la santé environnementale du Québec - Environmental Health Association of Québec, 1065 Montée Saint-Elmire, Saint Sauveur, QC, J0R 1R1, Canada, 1 5147955701, rohiniperis@aseq-ehaq.ca %K COVID-19 %K multiple chemical sensitivity %K Canada %K accessibility %K social isolation %K physical environment %K health care %K air pollution %K pollution %K air quality %K isolation %K social network %K social interaction %K lived experience %K sensitivity %K environment %K environmental %D 2024 %7 17.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Multiple chemical sensitivity (MCS) develops in response to repeated small-level chemical exposures or a major exposure in a subset of people, who then experience symptoms that can range from mild to debilitating when exposed to chemicals. The arrival of the COVID-19 pandemic and the stringent health measures put in place may have increased the burden for those living with MCS, as it became more challenging to avoid chemicals that trigger their condition. Objective: This study aimed to better understand the lived experience of Canadians living with MCS during the first year of the COVID-19 pandemic. Methods: An online questionnaire was created to ask participants to compare daily living during the pandemic to before March 11, 2020. Data were collected in January and February 2021. Three areas were investigated: (1) environmental exposures to chemical triggers from ambient air (pollution from industry, farming, and traffic) and indoor air (the smell of cleaning products, cooking odors, and smoke); (2) access to, and satisfaction with, health care visits; and (3) how people experiencing MCS rated contact with their social network. Results: In all, 119 Canadians who had lived with MCS for more than a year completed the questionnaire. The participant sample was mostly female (86.6%, n=103) and highly educated, with 57.1% (n=68) having a university degree. Slightly more than half (57.1%, n=68) were older than 55 years. McNemar chi-square and Wilcoxon signed rank tests were used to evaluate if there were statistically significant changes before (“prepandemic period”) and after (“postpandemic period”) March 11, 2020. Perceived exposure to pollution from a highway or a road was significantly decreased from the prepandemic to postpandemic period (z=–3.347; P<.001). Analysis of industry or power plants also suggested a significant decrease in the perceived exposure from the prepandemic to postpandemic period (z=–2.152; P=.04). Participants reported an increase in exposure to odors from disinfectants or sanitizers that entered their living environment (P<.001). There was a significant decrease between prepandemic and postpandemic levels of satisfaction when attending in-person meetings with a physician (z=–2.048; P=.04), yet there were no significant differences between prepandemic and postpandemic levels of satisfaction for online or telephone meetings with a physician. Although people with MCS experienced increased social isolation (P<.001), they also reported an increase in understanding from family (P=.03) and a decrease in stigma for wearing personal protective equipment (P<.001). Conclusions: During the first year of the COVID-19 pandemic, people with MCS were impacted by inaccessibility, loss of social support, and barriers to accessing health care. This study highlights unique challenges and possible benefits associated with the COVID-19 pandemic public health measures for individuals living with MCS. These findings can guide decision makers to improve policies on accessibility through appropriate accommodation measures. %M 39018551 %R 10.2196/48434 %U https://formative.jmir.org/2024/1/e48434 %U https://doi.org/10.2196/48434 %U http://www.ncbi.nlm.nih.gov/pubmed/39018551 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e50678 %T Estimating the Global and Regional Burden of Streptococcus pneumoniae Meningitis in Children: Protocol for a Systematic Review and Meta-Analysis %A Park,Jay J %A Tiefenbach,Jakov %A Anwar,Mohammed Ma'arij %A Narayanan,Sandhya %A Ope,Beatrice %A Bin Han,Selene Seo %A Ale,Boni Maxime %A Adeloye,Davies %A Rudan,Igor %+ Department of Bioengineering, Imperial College London, Royal School of Mines, South Kensington Campus, London, SW7 2AZ, United Kingdom, 44 7727006197, maarij.anwar22@imperial.ac.uk %K Streptococcus pneumoniae %K meningitis %K streptococcal meningitis %K pneumococcal meningits %K global burden %K pediatric meningitis %K infectious disease %K pneumonia %K sepsis %K infection %K infection prevention and control %K IPC %K child health %K global health %K systematic review %K pneumococcal %D 2024 %7 16.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Streptococcus pneumoniae (Spn) has been a leading cause of bacterial meningitis in children. The most recent estimation of the global burden of Spn meningitis indicates a positive trajectory in eliminating Spn through the implementation of pneumococcal conjugate vaccines. However, continuous monitoring and assessment of the disease burden are necessary due to the evidence of serotype replacement, antibiotic resistance, and the impact of the recent COVID-19 pandemic. Objective: The aim of this systematic review is to provide an updated and focused assessment of the global and regional burden of Spn meningitis in children, which can guide policies and strategies to reduce the disease burden. Methods: Population-based studies published from January 1, 2000, to January 1, 2022, were preliminarily searched from the electronic databases PubMed, Embase, Global Health (CABI), and CINAHL Plus without any language restrictions. Studies were included if they reported the incidence, prevalence, mortality, or case-fatality ratio (CFR) for Spn meningitis in children aged 0-4 years; meningitis was confirmed by cerebrospinal fluid culture; the study period was a minimum of 1 year; the number of reported cases was at least 10; and the study had no methodological ambiguities. The article screening process follows the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Characteristics including study period, setting, World Health Organization region, income level, vaccination information, and participant data (age, number of cases, deaths, sequelae, and risk factors) will be extracted from the included studies. Search results will be updated and incorporated into our review prior to finalizing the extraction of data. Generalized linear mixed models meta-analysis will be performed to estimate the pooled incidence and CFR. We will further assess the risk of bias and heterogeneity, and will perform subgroup and sensitivity analyses to provide a meaningful interpretation of the current burden and literature for pneumococcal meningitis. Results: Our preliminary search in December 2021 yielded 9295 articles. Out of 275 studies that were assessed with our eligibility criteria, 117 articles were included. Data extraction and analysis are expected to be complete by January 2025. We plan to publish the results from the full study, including an updated search in 2024, by March 2025. Conclusions: Given that the major burden of Spn meningitis affects children under the age of 5 years, this systematic review will provide a thorough understanding of the global burden of Spn meningitis in this vulnerable population over a span of 2 decades. Insights into incidence trends, geospatial distribution, risk factors, and sequelae will be valuable for stakeholders, policy makers, and the academic community. This information will aid in the ongoing monitoring of the disease and in enhancing targeted vaccine programs to further mitigate the impact of the disease on children worldwide. Trial Registration: PROSPERO CRD42021293110; https://tinyurl.com/kc3j5k4m International Registered Report Identifier (IRRID): DERR1-10.2196/50678 %M 39012685 %R 10.2196/50678 %U https://www.researchprotocols.org/2024/1/e50678 %U https://doi.org/10.2196/50678 %U http://www.ncbi.nlm.nih.gov/pubmed/39012685 %0 Journal Article %@ 2369-2960 %I %V 10 %N %P e49812 %T Predicting Efficacies of Fractional Doses of Vaccines by Using Neutralizing Antibody Levels: Systematic Review and Meta-Analysis %A Du,Zhanwei %A Liu,Caifen %A Bai,Yuan %A Wang,Lin %A Lim,Wey Wen %A Lau,Eric H Y %A Cowling,Benjamin J %K COVID-19 %K SARS-CoV-2 %K dose fractionation %K neutralizing antibody level %K vaccination %K review %K vaccine %D 2024 %7 12.7.2024 %9 %J JMIR Public Health Surveill %G English %X Background: With the emergence of SARS-CoV-2 variants that have eluded immunity from vaccines and prior infections, vaccine shortages and vaccine effectiveness pose unprecedented challenges for governments in expanding booster vaccination programs. The fractionation of vaccine doses might be an effective strategy for helping society to face these challenges, as fractional doses may have efficacies comparable with those of the standard doses. Objective: This study aims to investigate the relationship between vaccine immunogenicity and protection and to project efficacies of fractional doses of vaccines for COVID-19 by using neutralizing antibody levels. Methods: In this study, we analyzed the relationship between in vitro neutralization levels and the observed efficacies against both asymptomatic infection and symptomatic infection, using data from 13 studies of 10 COVID-19 vaccines and from convalescent cohorts. We further projected efficacies for fractional doses, using neutralization as an intermediate variable, based on immunogenicity data from 51 studies included in our systematic review. Results: In comparisons with the convalescent level, vaccine efficacy against asymptomatic infection and symptomatic infection increased from 8.8% (95% CI 1.4%-16.1%) to 71.8% (95% CI 63%-80.7%) and from 33.6% (95% CI 23.6%-43.6%) to 98.6% (95% CI 97.6%-99.7%), respectively, as the mean neutralization level increased from 0.1 to 10 folds of the convalescent level. Additionally, mRNA vaccines provided the strongest protection, which decreased slowly for fractional dosing with dosages between 50% and 100% of the standard dose. We also observed that although vaccine efficacy increased with the mean neutralization level, the rate of this increase was slower for vaccine efficacy against asymptomatic infection than for vaccine efficacy against symptomatic infection. Conclusions: Our results are consistent with studies on immune protection from SARS-CoV-2 infection. Based on our study, we expect that fractional-dose vaccination could provide partial immunity against SARS-CoV-2 and its variants. Our findings provide a theoretical basis for the efficacy of fractional-dose vaccines, serving as reference evidence for implementing fractional dosing vaccine policies in areas facing vaccine shortages and thereby mitigating disease burden. Fractional-dose vaccination could be a viable vaccination strategy comparable to full-dose vaccination and deserves further exploration. %R 10.2196/49812 %U https://publichealth.jmir.org/2024/1/e49812 %U https://doi.org/10.2196/49812 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e48396 %T The Association Between Depressive Symptoms and the Weekly Duration of Physical Activity Subset by Intensity and Domain: Population-Based, Cross-Sectional Analysis of the National Health and Nutrition Examination Survey From 2007 to 2018 %A Boparai,Josheil K %A Dunnett,Sarah %A Wu,Michelle %A Tassone,Vanessa K %A Duffy,Sophie F %A Zuluaga Cuartas,Valentina %A Chen,Ziming %A Jung,Hyejung %A Sabiston,Catherine M %A Lou,Wendy %A Bhat,Venkat %+ Interventional Psychiatry Program, St. Michael's Hospital, 193 Yonge Street, Floor Number 6-013, Toronto, ON, M5B1M8, Canada, 1 4163604000 ext 76404, venkat.bhat@utoronto.ca %K depressive disorder %K exercise %K physical activity intensity %K recreational physical activity %K work-related physical activity %K National Health and Nutrition Examination Survey %K NHANES %K nutrition surveys %K recreational activity %K physical activity %K depression %D 2024 %7 5.7.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Prior literature suggests a dose-response relationship between physical activity (PA) and depressive symptoms. The intensity and domain of PA are suggested to be critical to its protective effect against depression; however, existing literature has shown mixed results. Objective: The purpose of this population-based study is to examine the associations between depressive symptoms and weekly duration of (1) total PA and (2) PA subset by intensity, domain, or both. Methods: A cross-sectional analysis of National Health and Nutrition Examination Survey data from 2007 to 2018 was conducted using multivariable logistic and linear regression models and survey weights. Participants (N=29,730) were 20 years and older and completed the Physical Activity Questionnaire and Depression Screener. The primary outcome was the presence of depressive symptoms, and the secondary outcomes were cognitive-affective and somatic symptoms of depression. Results: Participants (N=29,730) had a weighted mean age of 47.62 (SD 16.99) years, and 15,133 (51.34%) were female. On average, participants without depressive symptoms engaged in 10.87 hours of total PA per week, whereas participants with depressive symptoms engaged in 8.82 hours (P<.001). No significant associations were seen between the weekly duration of total PA and depressive symptom odds, somatic, or cognitive-affective symptoms (all P>.05). Participants with an increased weekly duration of recreational PA had decreases in depressive symptom odds (adjusted odds ratio [aOR] 0.965, 95% CI 0.944-0.986) and in somatic (adjusted coefficient [aβ]=–0.016, 95% CI –0.022 to –0.009) and cognitive-affective (aβ=–0.015, 95% CI –0.023 to –0.007) symptoms. When recreational PA was subset by intensity, participants with an increased weekly duration of vigorous-intensity recreational PA had decreases in depressive symptom odds (aOR 0.926, 95% CI 0.883-0.972) and in somatic (aβ=–0.021, 95% CI –0.032 to –0.010) and cognitive-affective (aβ=–0.022, 95% CI –0.035 to –0.009) symptoms. However, significant associations were not seen for the weekly duration of work-related, moderate- or vigorous-intensity PAs (all P>.05). Conclusions: Findings suggest that recreational, not work-related PA is associated with reduced symptoms of depression. Future studies should explore the impact of the different types and contexts of PA on depressive symptomatology. %M 38968593 %R 10.2196/48396 %U https://www.i-jmr.org/2024/1/e48396 %U https://doi.org/10.2196/48396 %U http://www.ncbi.nlm.nih.gov/pubmed/38968593 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58040 %T Experiences of Governments and Public Health Agencies Regarding Crisis Communication During the COVID-19 Pandemic in the Digital Age: Protocol for a Systematic Review of Qualitative Studies %A Okuhara,Tsuyoshi %A Terada,Marina %A Okada,Hiroko %A Kiuchi,Takahiro %+ Department of Health Communication, School of Public Health, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan, 81 03 5800 8781, okuhara-ctr@umin.ac.jp %K COVID-19 %K health communication %K infodemic %K misinformation %K social media %K SARS-CoV-2 %K coronavirus %K pandemic %K infectious %K digital age %K systematic review %K internet %K public health %K government %K governments %K crisis communication %K qualitative %K methodology %K disinformation %K eHealth %K digital health %K medical informatics %D 2024 %7 27.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Governments and public health agencies worldwide experienced difficulties with social media–mediated infodemics on the internet during the COVID-19 pandemic. Existing public health crisis communication strategies need to be updated. However, crisis communication experiences of governments and public health agencies worldwide during the COVID-19 pandemic have not been systematically compiled, necessitating updated crisis communication strategies. Objective: This systematic review aims to collect and organize the crisis communication experiences of senders (ie, governments and public health agencies) during the COVID-19 pandemic. Our focus is on exploring the difficulties that governments and public health agencies experienced, best practices in crisis communication by governments and public health agencies during the COVID-19 pandemic in times of infodemic, and challenges that should be overcome in future public health crises. Methods: We plan to begin the literature search on May 1, 2024. We will search PubMed, MEDLINE, CINAHL, PsycINFO, PsycARTICLES, Communication Abstracts, and Web of Science. We will filter our database searches to search from the year 2020 and beyond. We will use a combination of keywords by referring to the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, and Research type) tool to search the abstracts in databases. We intend to include qualitative studies on crisis communication by governments and public health agencies (eg, officials, staff, health professionals, and researchers) to the public. Quantitative data–based studies will be excluded. Only papers written in English will be included. Data on study characteristics, study aim, participant characteristics, methodology, theoretical framework, object of crisis communication, and key results will be extracted. The methodological quality of eligible studies will be assessed using the Joanna Briggs Institute critical appraisal checklist for qualitative research. A total of 2 independent reviewers will share responsibility for screening publications, data extraction, and quality assessment. Disagreement will be resolved through discussion, and the third reviewer will be consulted, if necessary. The findings will be summarized in a table and a conceptual diagram and synthesized in a descriptive and narrative review. Results: The results will be systematically integrated and presented in a way that corresponds to our research objectives and interests. We expect the results of this review to be submitted for publication by the end of 2024. Conclusions: To our knowledge, this will be the first systematic review of the experiences of governments and public health agencies regarding their crisis communication to the public during the COVID-19 pandemic. This review will contribute to the future improvement of the guidelines for crisis communication by governments and public health agencies to the public. Trial Registration: PROSPERO CRD42024528975; https://tinyurl.com/4fjmd8te International Registered Report Identifier (IRRID): PRR1-10.2196/58040 %M 38935414 %R 10.2196/58040 %U https://www.researchprotocols.org/2024/1/e58040 %U https://doi.org/10.2196/58040 %U http://www.ncbi.nlm.nih.gov/pubmed/38935414 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e52686 %T The Association of Broadband Internet Use With Drug Overdose Mortality Rates in the United States: Cross-Sectional Analysis %A Karakis,Ioannis %A Kostandini,Genti %A Tsamakis,Konstantinos %A Zahirovic-Herbert,Velma %+ Department of Neurology, Emory University School of Medicine, 49 Jesse Hill Jr Dr SE, Atlanta, GA, 30303, United States, 1 404 727 6123, ioannis.karakis@emory.edu %K opioids %K broadband internet %K mortality %K public health %K digital divide %K access %K availability %K causal %K association %K correlation %K overdose %K drug abuse %K addiction %K substance abuse %K demographic %K United States %K population %D 2024 %7 26.6.2024 %9 Original Paper %J Online J Public Health Inform %G English %X Background: The availability and use of broadband internet play an increasingly important role in health care and public health. Objective: This study examined the associations between broadband internet availability and use with drug overdose deaths in the United States. Methods: We linked 2019 county-level drug overdose death data in restricted-access multiple causes of death files from the National Vital Statistics System at the US Centers for Disease Control and Prevention with the 2019 county-level broadband internet rollout data from the Federal Communications Commission and the 2019 county-level broadband usage data available from Microsoft’s Airband Initiative. Cross-sectional analysis was performed with the fixed-effects regression method to assess the association of broadband internet availability and usage with opioid overdose deaths. Our model also controlled for county-level socioeconomic characteristics and county-level health policy variables. Results: Overall, a 1% increase in broadband internet use was linked with a 1.2% increase in overall drug overdose deaths. No significant association was observed for broadband internet availability. Although similar positive associations were found for both male and female populations, the association varied across different age subgroups. The positive association on overall drug overdose deaths was the greatest among Hispanic and Non-Hispanic White populations. Conclusions: Broadband internet use was positively associated with increased drug overdose deaths among the overall US population and some subpopulations, even after controlling for broadband availability, sociodemographic characteristics, unemployment, and median household income. %M 38922664 %R 10.2196/52686 %U https://ojphi.jmir.org/2024/1/e52686 %U https://doi.org/10.2196/52686 %U http://www.ncbi.nlm.nih.gov/pubmed/38922664 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e42050 %T Malaria Vector Bionomics: Countrywide Surveillance Study on Implications for Malaria Elimination in India %A Rahi,Manju %A Mishra,AK %A Chand,Gyan %A Baharia,RK %A Hazara,RK %A Singh,SP %A Khan,Siraj %A Sreehari,U %A Kamaraju,Divya %A Kumar,Gaurav %A Gupta,Sanjeev Kumar %A Sharma,Amit %A Raghavendra,K %A Gunasekaran,K %A Singh,Om P %A Subbarao,Sarala K %+ Indian Council of Medical Research, V. Ramalingaswami Bhawan, PO Box Number 4911, Ansari Nagar, Delhi, 110029, India, 91 9999002837, drmanjurahi@gmail.com %K malaria %K bionomics %K sibling species %K insecticide resistance %K elimination %K India %D 2024 %7 17.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The biological characteristics of mosquito vectors vary, impacting their response to control measures. Thus, having up-to-date information on vector bionomics is essential to maintain the effectiveness of existing control strategies and tools, particularly as India aims for malaria elimination by 2030. Objective: This study aims to assess the proportions of vector species resting indoors and outdoors, determine their preference for host biting/feeding, identify transmission sites, and evaluate the susceptibility of vectors to insecticides used in public health programs. Methods: Mosquito collections were conducted in 13 districts across 8 Indian states from 2017 to 2020 using various methods to estimate their densities. Following morphological identification in the field, sibling species of Anopheles mosquitoes were identified molecularly using polymerase chain reaction (PCR)–specific alleles. Plasmodium falciparum and Plasmodium vivax infections in the vectors were detected using enzyme-linked immunosorbent assay (ELISA) and PCR assays. In addition, we assessed the insecticide susceptibility status of primary malaria vectors following the World Health Organization (WHO) protocol. Results: Anopheles culicifacies, a primary malaria vector, was collected (with a man-hour density ranging from 3.1 to 15.9) from all states of India except those in the northeastern region. Anopheles fluviatilis, another primary vector, was collected from the states of Madhya Pradesh, Maharashtra, Karnataka, and Odisha. In Haryana and Karnataka, An. culicifacies sibling species A predominated, whereas species C and E were predominant in Madhya Pradesh and Maharashtra. An. culicifacies displayed mainly endophilic behavior across all states, except in Madhya Pradesh, where the proportion of semigravid and gravid mosquitoes was nearly half of that of unfed mosquitoes. The human blood index of An. culicifacies ranged from 0.001 to 0.220 across all study sites. The sporozoite rate of An. culicifacies ranged from 0.06 to 4.24, except in Madhya Pradesh, where none of the vector mosquitoes were found to be infected with the Plasmodium parasite. In the study area, An. culicifacies exhibited resistance to DDT (dichlorodiphenyltrichloroethane; with <39% mortality). Moreover, it showed resistance to malathion (with mortality rates ranging from 49% to 78%) in all districts except Angul in Odisha and Palwal in Haryana. In addition, resistance to deltamethrin was observed in districts of Maharashtra, Gujarat, Haryana, and Karnataka. Conclusions: Our study offers vital insights into the prevalence, resting behavior, and sibling species composition of malaria vectors in India. It is evident from our findings that resistance development in An. culicifacies, the primary vector, to synthetic pyrethroids is on the rise in the country. Furthermore, the results of our study suggest a potential change in the resting behavior of An. culicifacies in Madhya Pradesh, although further studies are required to confirm this shift definitively. These findings are essential for the development of effective vector control strategies in India, aligning with the goal of malaria elimination by 2030. %M 38885497 %R 10.2196/42050 %U https://publichealth.jmir.org/2024/1/e42050 %U https://doi.org/10.2196/42050 %U http://www.ncbi.nlm.nih.gov/pubmed/38885497 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e57239 %T Development of a Real-Time Dashboard for Overdose Touchpoints: User-Centered Design Approach %A Salvi,Amey %A Gillenwater,Logan A %A Cockrum,Brandon P %A Wiehe,Sarah E %A Christian,Kaitlyn %A Cayton,John %A Bailey,Timothy %A Schwartz,Katherine %A Dir,Allyson L %A Ray,Bradley %A Aalsma,Matthew C %A Reda,Khairi %+ School of Informatics, Computing, and Engineering, Indiana University Indianapolis, 535 W Michigan St, Indianapolis, IN, 46202, United States, 1 317 274 5788, redak@iu.edu %K overdose prevention %K dashboards %K fatality review %K data integration %K visualizations %K visualization %K dashboard %K fatality %K death %K overdose %K overdoses %K overdosing %K prevention %K develop %K development %K design %K interview %K interviews %K focus group %K focus groups %K touchpoints %K touchpoint %K substance abuse %K drug abuse %D 2024 %7 11.6.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Overdose Fatality Review (OFR) is an important public health tool for shaping overdose prevention strategies in communities. However, OFR teams review only a few cases at a time, which typically represent a small fraction of the total fatalities in their jurisdiction. Such limited review could result in a partial understanding of local overdose patterns, leading to policy recommendations that do not fully address the broader community needs. Objective: This study explored the potential to enhance conventional OFRs with a data dashboard, incorporating visualizations of touchpoints—events that precede overdoses—to highlight prevention opportunities. Methods: We conducted 2 focus groups and a survey of OFR experts to characterize their information needs and design a real-time dashboard that tracks and measures decedents’ past interactions with services in Indiana. Experts (N=27) were engaged, yielding insights on essential data features to incorporate and providing feedback to guide the development of visualizations. Results: The findings highlighted the importance of showing decedents’ interactions with health services (emergency medical services) and the justice system (incarcerations). Emphasis was also placed on maintaining decedent anonymity, particularly in small communities, and the need for training OFR members in data interpretation. The developed dashboard summarizes key touchpoint metrics, including prevalence, interaction frequency, and time intervals between touchpoints and overdoses, with data viewable at the county and state levels. In an initial evaluation, the dashboard was well received for its comprehensive data coverage and its potential for enhancing OFR recommendations and case selection. Conclusions: The Indiana touchpoints dashboard is the first to display real-time visualizations that link administrative and overdose mortality data across the state. This resource equips local health officials and OFRs with timely, quantitative, and spatiotemporal insights into overdose risk factors in their communities, facilitating data-driven interventions and policy changes. However, fully integrating the dashboard into OFR practices will likely require training teams in data interpretation and decision-making. %M 38861717 %R 10.2196/57239 %U https://humanfactors.jmir.org/2024/1/e57239 %U https://doi.org/10.2196/57239 %U http://www.ncbi.nlm.nih.gov/pubmed/38861717 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52457 %T Electronic Health Literacy Scale-Web3.0 for Older Adults with Noncommunicable Diseases: Validation Study %A Cai,Wenfei %A Liang,Wei %A Liu,Huaxuan %A Zhou,Rundong %A Zhang,Jie %A Zhou,Lin %A Su,Ning %A Zhu,Hanxiao %A Yang,Yide %+ School of Physical Education, Shenzhen University, 3688 Nanhai Road, Nanshan District, Shenzhen, 518060, China, 86 15217940540, wliang1020@szu.edu.cn %K eHealth literacy %K measurement %K Web 3.0 %K psychometric properties %K NCD %K older adults %K noncommunicable diseases %K Electronic Health Literacy %K health literacy %K eHealth %K reliability %K validity %D 2024 %7 3.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: In the current digital era, eHealth literacy plays an indispensable role in health care and self-management among older adults with noncommunicable diseases (NCDs). Measuring eHealth literacy appropriately and accurately ensures the successful implementation and evaluation of pertinent research and interventions. However, existing eHealth literacy measures focus mainly on individuals’ abilities of accessing and comprehending eHealth information (Web1.0), whereas the capabilities for web-based interaction (Web2.0) and using eHealth information (Web3.0) have not been adequately evaluated. Objective: This study aimed to examine the reliability, validity, and measurement invariance of the eHealth Literacy Scale-Web3.0 (eHLS-Web3.0) among older adults with NCDs. Methods: A total of 642 Chinese older adults with NCDs (mean age 65.78, SD 3.91 years; 55.8% female) were recruited in the baseline assessment, of whom 134 (mean age 65.63, SD 3.99 years; 58.2% female) completed the 1-month follow-up assessment. Baseline measures included the Chinese version of the 24-item 3D eHLS-Web3.0, the Chinese version of the 8-item unidimensional eHealth Literacy Scale (eHEALS), and demographic information. Follow-up measures included the 24-item eHLS-Web3.0 and accelerometer-measured physical activity and sedentary behavior. A series of statistical analyses, for example, Cronbach α, composite reliability coefficient (CR), confirmatory factor analysis (CFA), and multigroup CFA, were performed to examine the internal consistency and test-retest reliabilities, as well as the construct, concurrent, convergent, discriminant, and predictive validities, and the measurement invariance of the eHLS-Web3.0 across gender, education level, and residence. Results: Cronbach α and CR were within acceptable ranges of 0.89-0.94 and 0.90-0.97, respectively, indicating adequate internal consistency of the eHLS-Web3.0 and its subscales. The eHLS-Web3.0 also demonstrated cross-time stability, with baseline and follow-up measures showing a significant intraclass correlation of 0.81-0.91. The construct validity of the 3D structure model of the eHLS-Web3.0 was supported by confirmatory factor analyses. The eHLS-Web3.0 exhibited convergent validity with an average variance extracted value of 0.58 and a CR value of 0.97. Discriminant validity was supported by CFA results for a proposed 4-factor model integrating the 3 eHLS-Web3.0 subscales and eHEALS. The predictive validity of the eHLS-Web3.0 for health behaviors was supported by significant associations of the eHLS-Web3.0 with light physical activity (β=.36, P=.004), moderate to vigorous physical activity (β=.49, P<.001), and sedentary behavior (β=–.26, P=.002). Finally, the measurement invariance of the eHLS-Web3.0 across gender, education level, and residence was supported by the establishment of configural, metric, strong, and strict invariances. Conclusions: The present study provides timely empirical evidence on the reliability, validity, and measurement invariance of the eHLS-Web3.0, suggesting that the 24-item 3D eHLS-Web3.0 is an appropriate and valid tool for measuring eHealth literacy among older adults with NCDs within the Web3.0 sphere. %M 38830207 %R 10.2196/52457 %U https://www.jmir.org/2024/1/e52457 %U https://doi.org/10.2196/52457 %U http://www.ncbi.nlm.nih.gov/pubmed/38830207 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e46904 %T Vulnerability to Cyberattacks and Sociotechnical Solutions for Health Care Systems: Systematic Review %A Ewoh,Pius %A Vartiainen,Tero %+ School of Technology and Innovations, Information Systems Science, University of Vaasa, Wolffintie 32, Vaasa, 65200, Finland, 358 414888477, pius.ewoh@uwasa.fi %K health care systems %K cybersecurity %K sociotechnical %K medical device %K secure systems development %K training %K ransomware %K data breaches %K protected health information %K patient safety %D 2024 %7 31.5.2024 %9 Review %J J Med Internet Res %G English %X Background: Health care organizations worldwide are faced with an increasing number of cyberattacks and threats to their critical infrastructure. These cyberattacks cause significant data breaches in digital health information systems, which threaten patient safety and privacy. Objective: From a sociotechnical perspective, this paper explores why digital health care systems are vulnerable to cyberattacks and provides sociotechnical solutions through a systematic literature review (SLR). Methods: An SLR using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was conducted by searching 6 databases (PubMed, Web of Science, ScienceDirect, Scopus, Institute of Electrical and Electronics Engineers, and Springer) and a journal (Management Information Systems Quarterly) for articles published between 2012 and 2022 and indexed using the following keywords: “(cybersecurity OR cybercrime OR ransomware) AND (healthcare) OR (cybersecurity in healthcare).” Reports, review articles, and industry white papers that focused on cybersecurity and health care challenges and solutions were included. Only articles published in English were selected for the review. Results: In total, 5 themes were identified: human error, lack of investment, complex network-connected end-point devices, old legacy systems, and technology advancement (digitalization). We also found that knowledge applications for solving vulnerabilities in health care systems between 2012 to 2022 were inconsistent. Conclusions: This SLR provides a clear understanding of why health care systems are vulnerable to cyberattacks and proposes interventions from a new sociotechnical perspective. These solutions can serve as a guide for health care organizations in their efforts to prevent breaches and address vulnerabilities. To bridge the gap, we recommend that health care organizations, in partnership with educational institutions, develop and implement a cybersecurity curriculum for health care and intelligence information sharing through collaborations; training; awareness campaigns; and knowledge application areas such as secure design processes, phase-out of legacy systems, and improved investment. Additional studies are needed to create a sociotechnical framework that will support cybersecurity in health care systems and connect technology, people, and processes in an integrated manner. %M 38820579 %R 10.2196/46904 %U https://www.jmir.org/2024/1/e46904 %U https://doi.org/10.2196/46904 %U http://www.ncbi.nlm.nih.gov/pubmed/38820579 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49383 %T Examining the Role of Information Behavior in Linking Cancer Risk Perception and Cancer Worry to Cancer Fatalism in China: Cross-Sectional Survey Study %A Zhang,Lianshan %A Jiang,Shaohai %+ Department of Communications and New Media, National University of Singapore, Blk AS6, 11 Computing Drive, Singapore, 117416, Singapore, 65 6516 2003, cnmjs@nus.edu.sg %K cancer fatalism %K cancer risk perception %K cancer worry %K health information seeking %K information avoidance %D 2024 %7 31.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Reducing cancer fatalism is essential because of its detrimental impact on cancer-related preventive behaviors. However, little is known about factors influencing individuals’ cancer fatalism in China. Objective: With a general basis of the extended parallel process model, this study aims to examine how distinct cancer-related mental conditions (risk perception and worry) and different information behaviors (information seeking vs avoidance) become associated with cancer fatalism, with an additional assessment of the moderating effect of information usefulness. Methods: Data were drawn from the Health Information National Trends Survey in China, which was conducted in 2017 (N=2358). Structural equation modeling and bootstrapping methods were performed to test a moderated mediation model and hypothesized relationships. Results: The results showed that cancer risk perception and cancer worry were positively associated with online health information seeking. In addition, cancer worry was positively related to cancer information avoidance. Moreover, online health information seeking was found to reduce cancer fatalism, while cancer information avoidance was positively associated with cancer fatalism. The results also indicated that the perceived usefulness of cancer information moderated this dual-mediation pathway. Conclusions: The national survey data indicate that cancer mental conditions should not be treated as homogeneous entities, given their varying functions and effects. Apart from disseminating useful cancer information to encourage individuals to adaptively cope with cancer threats, we advocate for health communication programs to reduce cancer information avoidance to alleviate fatalistic beliefs about cancer prevention. %M 38819919 %R 10.2196/49383 %U https://www.jmir.org/2024/1/e49383 %U https://doi.org/10.2196/49383 %U http://www.ncbi.nlm.nih.gov/pubmed/38819919 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53321 %T Prevalence and Factors Associated With Willingness to Sustain Pandemic-Induced Digital Work in the General Population and Moderating Effects of Screen Hours: Cross-Sectional Study %A Li,Jiaying %A Fong,Daniel Yee Tak %A Ho,Mandy Man %A Choi,Edmond Pui Hang %A Lok,Kris Yuet Wan %A Lee,Jung Jae %A Duan,WenJie %A Wong,Janet Yuen Ha %A Lin,Chia-Chin %+ School of Nursing, The University of Hong Kong, 5/F, Academic Building 3 Sassoon Road, Pokfulam, Hong Kong SAR, 999077, China (Hong Kong), 852 39176645, dytfong@hku.hk %K COVID-19 pandemic %K digital work %K willingness to sustain %K screen time %K general population %D 2024 %7 28.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The pandemic has accelerated digital work transformation, yet little is known about individuals’ willingness to sustain such digital modes and its associated factors. A better understanding of this willingness and its drivers is crucial for guiding the development of future digital work infrastructure, training programs, and strategies to monitor and prevent related health issues. Objective: This study aims to quantify the general population’s willingness to sustain pandemic-induced digital work, identify its associated factors, and examine how screen time moderates these relationships. Methods: A cross-sectional study was conducted targeting Hong Kong residents aged ≥18 years who have increased engagement in digital work since the pandemic. Data were collected through self-reported, web-based surveys. Descriptive statistics determined prevalence rates, while structured multiphase logistic regression identified associated factors and explored the moderating effects of screen hour levels. Results: This unfunded study enrolled 1014 participants from May 2 to June 24, 2022, and completed data analysis within 3 months after data collection. A total of 391 (38.6%; 95% CI 35.6%-41.6%) participants expressed willingness to sustain digital work. Positive factors associated with this willingness included being an employee (odds ratio [OR] 3.12, 95% CI 1.59-6.45; P=.001), being health professionals (OR 3.32, 95% CI 1.49-7.82; P=.004), longer screen hours (OR 1.09, 95% CI 1.03-1.15; P=.002), and higher depression levels (OR 1.20, 95% CI 1.01-1.44; P=.04). Conversely, negatively associated factors included older age (OR 0.87, 95% CI 0.81-0.94; P=.001), extroversion (OR 0.66, 95% CI 0.51-0.86; P=.002), higher eHealth literacy (OR 0.96, 95% CI 0.93-0.98; P<.001), perceived greater susceptibility to COVID-19 (OR 0.84, 95% CI 0.74-0.96; P=.009), residence in a high-severity COVID-19 community (OR 0.73, 95% CI 0.63-0.84; P<.001), having infected individuals in the immediate social circle (OR 0.64, 95% CI 0.46-0.88; P=.006), higher BMI (OR 0.94, 95% CI 0.90-0.99; P=.02), feelings of being out of control (OR 0.96, 95% CI 0.93-0.98; P=.002), and higher fear of COVID-19 (OR 0.96, 95% CI 0.94-0.98; P=.001). In addition, a moderating effect of screen hour level (high: >8 h/d; low: ≤8 h/d) influenced the association among 10 factors related to willingness to sustain pandemic-induced digital work, including age, education level, household size, needs for regular medical care, BMI, frequency of both vigorous and moderate physical activities, perceived COVID-19 severity, immediate social circle COVID-19 presence, and fear of COVID-19 (all P values for interaction <.05). Conclusions: The substantial willingness of the general population to sustain digital work after the pandemic highlights the need for robust telework infrastructure, thorough monitoring of adverse health outcomes, and the potential to expand telehealth services among this group. The identification of factors influencing this willingness and the moderating role of screen hours inform the development of personalized strategies to enhance digital work acceptance where needed. %M 38805704 %R 10.2196/53321 %U https://www.jmir.org/2024/1/e53321 %U https://doi.org/10.2196/53321 %U http://www.ncbi.nlm.nih.gov/pubmed/38805704 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e51191 %T Modeling the Regional Distribution of International Travelers in Spain to Estimate Imported Cases of Dengue and Malaria: Statistical Inference and Validation Study %A García-García,David %A Fernández-Martínez,Beatriz %A Bartumeus,Frederic %A Gómez-Barroso,Diana %+ Department of Communicable Diseases, National Centre of Epidemiology, Instituto de Salud Carlos III, Monforte de Lemos 5, Madrid, 28029, Spain, 34 91 822 26 46, dawex14@gmail.com %K epidemiology %K imported infections %K modeling %K surveillance system %K vector-borne diseases %D 2024 %7 27.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Understanding the patterns of disease importation through international travel is paramount for effective public health interventions and global disease surveillance. While global airline network data have been used to assist in outbreak prevention and effective preparedness, accurately estimating how these imported cases disseminate locally in receiving countries remains a challenge. Objective: This study aimed to describe and understand the regional distribution of imported cases of dengue and malaria upon arrival in Spain via air travel. Methods: We have proposed a method to describe the regional distribution of imported cases of dengue and malaria based on the computation of the “travelers’ index” from readily available socioeconomic data. We combined indicators representing the main drivers for international travel, including tourism, economy, and visits to friends and relatives, to measure the relative appeal of each region in the importing country for travelers. We validated the resulting estimates by comparing them with the reported cases of malaria and dengue in Spain from 2015 to 2019. We also assessed which motivation provided more accurate estimates for imported cases of both diseases. Results: The estimates provided by the best fitted model showed high correlation with notified cases of malaria (0.94) and dengue (0.87), with economic motivation being the most relevant for imported cases of malaria and visits to friends and relatives being the most relevant for imported cases of dengue. Conclusions: Factual descriptions of the local movement of international travelers may substantially enhance the design of cost-effective prevention policies and control strategies, and essentially contribute to decision-support systems. Our approach contributes in this direction by providing a reliable estimate of the number of imported cases of nonendemic diseases, which could be generalized to other applications. Realistic risk assessments will be obtained by combining this regional predictor with the observed local distribution of vectors. %M 38801767 %R 10.2196/51191 %U https://publichealth.jmir.org/2024/1/e51191 %U https://doi.org/10.2196/51191 %U http://www.ncbi.nlm.nih.gov/pubmed/38801767 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e54958 %T Geospatial Imprecision With Constraints for Precision Public Health: Algorithm Development and Validation %A Harris,Daniel %A Delcher,Chris %+ Institute for Biomedical Informatics, University of Kentucky, Healthy Kentucky Research Building, Room 361, 760 Press Avenue, Lexington, KY, 40508, United States, 1 8593237100, daniel.harris@uky.edu %K social determinants of health %K geocoding %K privacy %K poverty %K obfuscation %K security %K confidentiality %K low income %K geography %K geographic %K location %K locations %K spatial %K geospatial %K precision %D 2024 %7 21.5.2024 %9 Original Paper %J Online J Public Health Inform %G English %X Background: Location and environmental social determinants of health are increasingly important factors in both an individual’s health and the monitoring of community-level public health issues. Objective: We aimed to measure the extent to which location obfuscation techniques, designed to protect an individual’s privacy, can unintentionally shift geographical coordinates into neighborhoods with significantly different socioeconomic demographics, which limits the precision of findings for public health stakeholders. Methods: Point obfuscation techniques intentionally blur geographic coordinates to conceal the original location. The pinwheel obfuscation method is an existing technique in which a point is moved along a pinwheel-like path given a randomly chosen angle and a maximum radius; we evaluate the impact of this technique using 2 data sets by comparing the demographics of the original point and the resulting shifted point by cross-referencing data from the United States Census Bureau. Results: Using poverty measures showed that points from regions of low poverty may be shifted to regions of high poverty; similarly, points in regions with high poverty may be shifted into regions of low poverty. We varied the maximum allowable obfuscation radius; the mean difference in poverty rate before and after obfuscation ranged from 6.5% to 11.7%. Additionally, obfuscation inadvertently caused false hot spots for deaths by suicide in Cook County, Illinois. Conclusions: Privacy concerns require patient locations to be imprecise to protect against risk of identification; precision public health requires accuracy. We propose a modified obfuscation technique that is constrained to generate a new point within a specified census-designated region to preserve both privacy and analytical accuracy by avoiding demographic shifts. %M 38772021 %R 10.2196/54958 %U https://ojphi.jmir.org/2024/1/e54958 %U https://doi.org/10.2196/54958 %U http://www.ncbi.nlm.nih.gov/pubmed/38772021 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51496 %T Reporting of Ethical Considerations in Qualitative Research Utilizing Social Media Data on Public Health Care: Scoping Review %A Zhang,Yujie %A Fu,Jiaqi %A Lai,Jie %A Deng,Shisi %A Guo,Zihan %A Zhong,Chuhan %A Tang,Jianyao %A Cao,Wenqiong %A Wu,Yanni %+ Nanfang Hospital, Southern Medical University, No 1838 Guangzhou Avenue North, Baiyun District, Guangdong Province, Guangzhou, 510515, China, 86 02061641192, yanniwuSMU@126.com %K qualitative research %K informed consent %K ethics approval %K privacy %K internet community %D 2024 %7 17.5.2024 %9 Review %J J Med Internet Res %G English %X Background: The internet community has become a significant source for researchers to conduct qualitative studies analyzing users’ views, attitudes, and experiences about public health. However, few studies have assessed the ethical issues in qualitative research using social media data. Objective: This study aims to review the reportage of ethical considerations in qualitative research utilizing social media data on public health care. Methods: We performed a scoping review of studies mining text from internet communities and published in peer-reviewed journals from 2010 to May 31, 2023. These studies, limited to the English language, were retrieved to evaluate the rates of reporting ethical approval, informed consent, and privacy issues. We searched 5 databases, that is, PubMed, Web of Science, CINAHL, Cochrane, and Embase. Gray literature was supplemented from Google Scholar and OpenGrey websites. Studies using qualitative methods mining text from the internet community focusing on health care topics were deemed eligible. Data extraction was performed using a standardized data extraction spreadsheet. Findings were reported using PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Results: After 4674 titles, abstracts, and full texts were screened, 108 studies on mining text from the internet community were included. Nearly half of the studies were published in the United States, with more studies from 2019 to 2022. Only 59.3% (64/108) of the studies sought ethical approval, 45.3% (49/108) mentioned informed consent, and only 12.9% (14/108) of the studies explicitly obtained informed consent. Approximately 86% (12/14) of the studies that reported informed consent obtained digital informed consent from participants/administrators, while 14% (2/14) did not describe the method used to obtain informed consent. Notably, 70.3% (76/108) of the studies contained users’ written content or posts: 68% (52/76) contained verbatim quotes, while 32% (24/76) paraphrased the quotes to prevent traceability. However, 16% (4/24) of the studies that paraphrased the quotes did not report the paraphrasing methods. Moreover, 18.5% (20/108) of the studies used aggregated data analysis to protect users’ privacy. Furthermore, the rates of reporting ethical approval were different between different countries (P=.02) and between papers that contained users’ written content (both direct and paraphrased quotes) and papers that did not contain users’ written content (P<.001). Conclusions: Our scoping review demonstrates that the reporting of ethical considerations is widely neglected in qualitative research studies using social media data; such studies should be more cautious in citing user quotes to maintain user privacy. Further, our review reveals the need for detailed information on the precautions of obtaining informed consent and paraphrasing to reduce the potential bias. A national consensus of ethical considerations such as ethical approval, informed consent, and privacy issues is needed for qualitative research of health care using social media data of internet communities. %M 38758590 %R 10.2196/51496 %U https://www.jmir.org/2024/1/e51496 %U https://doi.org/10.2196/51496 %U http://www.ncbi.nlm.nih.gov/pubmed/38758590 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52843 %T National Public Health Dashboards: Protocol for a Scoping Review %A Yanovitzky,Itzhak %A Stahlman,Gretchen %A Quow,Justine %A Ackerman,Matthew %A Perry,Yehuda %A Kim,Miriam %+ School of Communication & Information, Rutgers University, 4 Huntington St, New Brunswick, NJ, 08901, United States, 1 848 932 8852, itzhak@rutgers.edu %K dashboard %K scoping review %K public health %K design %K development %K implementation %K evaluation %K user need %K protocol %K data dashboards %K audiences %K audience %K systematic treatment %K public health data dashboards %K PRISMA-ScR %K snowballing techniques %K gray literature sources %K evidence-informed framework %K framework %K COVID-19 %K pandemic %D 2024 %7 16.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic highlighted the importance of robust public health data systems and the potential utility of data dashboards for ensuring access to critical public health data for diverse groups of stakeholders and decision makers. As dashboards are becoming ubiquitous, it is imperative to consider how they may be best integrated with public health data systems and the decision-making routines of diverse audiences. However, additional progress on the continued development, improvement, and sustainability of these tools requires the integration and synthesis of a largely fragmented scholarship regarding the purpose, design principles and features, successful implementation, and decision-making supports provided by effective public health data dashboards across diverse users and applications. Objective: This scoping review aims to provide a descriptive and thematic overview of national public health data dashboards including their purpose, intended audiences, health topics, design elements, impact, and underlying mechanisms of use and usefulness of these tools in decision-making processes. It seeks to identify gaps in the current literature on the topic and provide the first-of-its-kind systematic treatment of actionability as a critical design element of public health data dashboards. Methods: The scoping review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The review considers English-language, peer-reviewed journal papers, conference proceedings, book chapters, and reports that describe the design, implementation, and evaluation of a public health dashboard published between 2000 and 2023. The search strategy covers scholarly databases (CINAHL, PubMed, Medline, and Web of Science) and gray literature sources and uses snowballing techniques. An iterative process of testing for and improving intercoder reliability was implemented to ensure that coders are properly trained to screen documents according to the inclusion criteria prior to beginning the full review of relevant papers. Results: The search process initially identified 2544 documents, including papers located via databases, gray literature searching, and snowballing. Following the removal of duplicate documents (n=1416), nonrelevant items (n=839), and items classified as literature reviews and background information (n=73), 216 documents met the inclusion criteria: US case studies (n=90) and non-US case studies (n=126). Data extraction will focus on key variables, including public health data characteristics; dashboard design elements and functionalities; intended users, usability, logistics, and operation; and indicators of usefulness and impact reported. Conclusions: The scoping review will analyze the goals, design, use, usefulness, and impact of public health data dashboards. The review will also inform the continued development and improvement of these tools by analyzing and synthesizing current practices and lessons emerging from the literature on the topic and proposing a theory-grounded and evidence-informed framework for designing, implementing, and evaluating public health data dashboards. International Registered Report Identifier (IRRID): DERR1-10.2196/52843 %M 38753428 %R 10.2196/52843 %U https://www.researchprotocols.org/2024/1/e52843 %U https://doi.org/10.2196/52843 %U http://www.ncbi.nlm.nih.gov/pubmed/38753428 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54768 %T Social Transfers for Exclusive Breastfeeding (STEB) Intervention in Lao People’s Democratic Republic: Protocol for a Randomized Controlled Trial %A Sonephet,Souliviengkham %A Kounnavong,Sengchanh %A Zinsstag,Lucienne %A Vonaesch,Pascale %A Sayasone,Somphou %A Siengsounthone,Latsamy %A Odermatt,Peter %A Fink,Günther %A Wallenborn,Jordyn Tinka %+ Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, Switzerland, 41 765250183, jordyn.wallenborn@swisstph.ch %K breastfeeding %K lactation %K human milk %K breastmilk %K child %K infant %K health %K growth and development %K cash transfer %K incentive %K intervention %D 2024 %7 3.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Children in Lao People’s Democratic Republic (Lao PDR) receive suboptimal nutrition because of low breastfeeding rates, undermining their developmental potential. While major public health campaigns have attempted to increase breastfeeding rates, they have been largely unsuccessful. One explanation for these unsuccessful interventions is the economic and financial constraints faced by mothers. A potential solution for alleviating these pressures is providing social transfers to support breastfeeding; defined as a cash or in-kind transfer. Capitalizing on key strategies used in previous social transfer programs, we will assess the effectiveness of social transfer intervention for increasing exclusive breastfeeding rates in Vientiane, Lao PDR. Objective: This study aims to conduct a randomized controlled trial (RCT) designed to assess whether social transfers can increase exclusive breastfeeding rates in Vientiane Capital, Lao PDR. Methods: A prospective, parallel cluster-RCT was conducted among 300 mothers who recently gave birth and initiated breastfeeding. Enrolling 100 participants for each intervention arm provided us with 80% power to detect an increase in exclusive breastfeeding from the anticipated 21% in the control arm to 40% in either of the 2 intervention arms. Mother-infant dyads were enrolled at approximately 1 month post partum. Follow-up visits will occur at 6 months, 1 year, 2 years, and 3 years post partum; with the ambition to extend the follow-up period. Mother-infant dyads were enrolled between August 2022 and April 2023 with follow-up until 3 years post partum (2026). A local study team comprised of 2 nurses and 2 laboratory technicians is responsible for enrollment and follow-up of participants. Participants were randomly assigned to one of three groups during the baseline, 1-month visit: (1) control group, no social transfer; (2) intervention group 1, an unconditional social transfer at 6 months post partum; and (3) intervention group 2, a social transfer at 6 months post partum conditional upon mothers exclusively breastfeeding. All groups received educational materials supporting mothers to exclusively breastfeed. The primary end point will be exclusive breastfeeding at 6 months post partum. Secondary end points will include exclusive and complementary breastfeeding duration, childhood wasting and stunting, child growth, maternal and infant stress, predictors of early breastfeeding cessation, intestinal inflammation, anemia, maternal weight loss, maternal blood pressure, maternal anxiety, and GRIT personality score. Questionnaires and physical examinations were used to collect information. Results: As of November 2023, the study has enrolled 300 participants. Study participation is ongoing until December 2026 at minimum. Over the study lifetime, 93% have completed all visits. Conclusions: We see potential for a long-term program that may be implemented in other low- or lower-middle-income countries with only minor modifications. The RCT will be used as a basis for observational studies and to investigate the impact of human milk on child fecal microbiota and growth. Trial Registration: ClinicalTrials.gov NCT05665049; https://clinicaltrials.gov/study/NCT05665049 International Registered Report Identifier (IRRID): DERR1-10.2196/54768 %M 38700928 %R 10.2196/54768 %U https://www.researchprotocols.org/2024/1/e54768 %U https://doi.org/10.2196/54768 %U http://www.ncbi.nlm.nih.gov/pubmed/38700928 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53830 %T The Effect of Everyday-Life Social Contact on Pain %A Weiß,Martin %A Gründahl,Marthe %A Jachnik,Annalena %A Lampe,Emilia Caya %A Malik,Ishitaa %A Rittner,Heike Lydia %A Sommer,Claudia %A Hein,Grit %+ University Hospital Würzburg, Center of Mental Health, Department of Psychiatry, Psychosomatic and Psychotherapy, Translational Social Neuroscience Unit, Margarete-Höppel-Platz 1, Würzburg, 97080, Germany, 49 931 201 77412, weiss_m11@ukw.de %K social contact %K pain %K ecological momentary assessment %D 2024 %7 30.4.2024 %9 Viewpoint %J J Med Internet Res %G English %X Pain is a biopsychosocial phenomenon, resulting from the interplay between physiological and psychological processes and social factors. Given that humans constantly interact with others, the effect of social factors is particularly relevant. Documenting the significance of the social modulation of pain, an increasing number of studies have investigated the effect of social contact on subjective pain intensity and pain-related physiological changes. While evidence suggests that social contact can alleviate pain, contradictory findings indicate an increase in pain intensity and a deterioration of pain coping strategies. This evidence primarily stems from studies examining the effect of social contact on pain within highly controlled laboratory conditions. Moreover, pain assessments often rely on one-time subjective reports of average pain intensity across a predefined period. Ecological momentary assessments (EMAs) can circumvent these problems, as they can capture diverse aspects of behavior and experiences multiple times a day, in real time, with high resolution, and within naturalistic and ecologically valid settings. These multiple measures allow for the examination of fluctuations of pain symptoms throughout the day in relation to affective, cognitive, behavioral, and social factors. In this opinion paper, we review the current state and future relevance of EMA-based social pain research in daily life. Specifically, we examine whether everyday-life social support reduces or enhances pain. The first part of the paper provides a comprehensive overview of the use of EMA in pain research and summarizes the main findings. The review of the relatively limited number of existing EMA studies shows that the association between pain and social contact in everyday life depends on numerous factors, including pain syndromes, temporal dynamics, the nature of social interactions, and characteristics of the interaction partners. In line with laboratory research, there is evidence that everyday-life social contact can alleviate, but also intensify pain, depending on the type of social support. Everyday-life emotional support seems to reduce pain, while extensive solicitous support was found to have opposite effects. Moreover, positive short-term effects of social support can be overshadowed by other symptoms such as fatigue. Overall, gathering and integrating experiences from a patient’s social environment can offer valuable insights. These insights can help interpret dynamics in pain intensity and accompanying symptoms such as depression or fatigue. We conclude that factors determining the reducing versus enhancing effects of social contact on pain need to be investigated more thoroughly. We advocate EMA as the assessment method of the future and highlight open questions that should be addressed in future EMA studies on pain and the potential of ecological momentary interventions for pain treatment. %M 38687594 %R 10.2196/53830 %U https://www.jmir.org/2024/1/e53830 %U https://doi.org/10.2196/53830 %U http://www.ncbi.nlm.nih.gov/pubmed/38687594 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e51880 %T Now Is the Time to Strengthen Government-Academic Data Infrastructures to Jump-Start Future Public Health Crisis Response %A Lee,Jian-Sin %A Tyler,Allison R B %A Veinot,Tiffany Christine %A Yakel,Elizabeth %+ School of Information, University of Michigan, 105 S State St, Ann Arbor, MI, 48109-1285, United States, 1 734 389 9552, jianslee@umich.edu %K COVID-19 %K crisis response %K cross-sector collaboration %K data infrastructures %K data science %K data sharing %K pandemic %K public health %D 2024 %7 24.4.2024 %9 Viewpoint %J JMIR Public Health Surveill %G English %X During public health crises, the significance of rapid data sharing cannot be overstated. In attempts to accelerate COVID-19 pandemic responses, discussions within society and scholarly research have focused on data sharing among health care providers, across government departments at different levels, and on an international scale. A lesser-addressed yet equally important approach to sharing data during the COVID-19 pandemic and other crises involves cross-sector collaboration between government entities and academic researchers. Specifically, this refers to dedicated projects in which a government entity shares public health data with an academic research team for data analysis to receive data insights to inform policy. In this viewpoint, we identify and outline documented data sharing challenges in the context of COVID-19 and other public health crises, as well as broader crisis scenarios encompassing natural disasters and humanitarian emergencies. We then argue that government-academic data collaborations have the potential to alleviate these challenges, which should place them at the forefront of future research attention. In particular, for researchers, data collaborations with government entities should be considered part of the social infrastructure that bolsters their research efforts toward public health crisis response. Looking ahead, we propose a shift from ad hoc, intermittent collaborations to cultivating robust and enduring partnerships. Thus, we need to move beyond viewing government-academic data interactions as 1-time sharing events. Additionally, given the scarcity of scholarly exploration in this domain, we advocate for further investigation into the real-world practices and experiences related to sharing data from government sources with researchers during public health crises. %M 38656780 %R 10.2196/51880 %U https://publichealth.jmir.org/2024/1/e51880 %U https://doi.org/10.2196/51880 %U http://www.ncbi.nlm.nih.gov/pubmed/38656780 %0 Journal Article %@ 2291-9694 %I %V 12 %N %P e48007 %T Reducing Firearm Access for Suicide Prevention: Implementation Evaluation of the Web-Based “Lock to Live” Decision Aid in Routine Health Care Encounters %A Richards,Julie Angerhofer %A Kuo,Elena %A Stewart,Christine %A Shulman,Lisa %A Parrish,Rebecca %A Whiteside,Ursula %A Boggs,Jennifer M %A Simon,Gregory E %A Rowhani-Rahbar,Ali %A Betz,Marian E %K suicide prevention %K firearm %K internet %K implementation %K suicide %K prevention %K decision aid %K risk %K feasible %K support %K evaluation %K mental health %K electronic health record %K tool %D 2024 %7 22.4.2024 %9 %J JMIR Med Inform %G English %X Background: “Lock to Live” (L2L) is a novel web-based decision aid for helping people at risk of suicide reduce access to firearms. Researchers have demonstrated that L2L is feasible to use and acceptable to patients, but little is known about how to implement L2L during web-based mental health care and in-person contact with clinicians. Objective: The goal of this project was to support the implementation and evaluation of L2L during routine primary care and mental health specialty web-based and in-person encounters. Methods: The L2L implementation and evaluation took place at Kaiser Permanente Washington (KPWA)—a large, regional, nonprofit health care system. Three dimensions from the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) model—Reach, Adoption, and Implementation—were selected to inform and evaluate the implementation of L2L at KPWA (January 1, 2020, to December 31, 2021). Electronic health record (EHR) data were used to purposefully recruit adult patients, including firearm owners and patients reporting suicidality, to participate in semistructured interviews. Interview themes were used to facilitate L2L implementation and inform subsequent semistructured interviews with clinicians responsible for suicide risk mitigation. Audio-recorded interviews were conducted via the web, transcribed, and coded, using a rapid qualitative inquiry approach. A descriptive analysis of EHR data was performed to summarize L2L reach and adoption among patients identified at high risk of suicide. Results: The initial implementation consisted of updates for clinicians to add a URL and QR code referencing L2L to the safety planning EHR templates. Recommendations about introducing L2L were subsequently derived from the thematic analysis of semistructured interviews with patients (n=36), which included (1) “have an open conversation,” (2) “validate their situation,” (3) “share what to expect,” (4) “make it accessible and memorable,” and (5) “walk through the tool.” Clinicians’ interviews (n=30) showed a strong preference to have L2L included by default in the EHR-based safety planning template (in contrast to adding it manually). During the 2-year observation period, 2739 patients reported prior-month suicide attempt planning or intent and had a documented safety plan during the study period, including 745 (27.2%) who also received L2L. Over four 6-month subperiods of the observation period, L2L adoption rates increased substantially from 2% to 29% among primary care clinicians and from <1% to 48% among mental health clinicians. Conclusions: Understanding the value of L2L from users’ perspectives was essential for facilitating implementation and increasing patient reach and clinician adoption. Incorporating L2L into the existing system-level, EHR-based safety plan template reduced the effort to use L2L and was likely the most impactful implementation strategy. As rising suicide rates galvanize the urgency of prevention, the findings from this project, including L2L implementation tools and strategies, will support efforts to promote safety for suicide prevention in health care nationwide. %R 10.2196/48007 %U https://medinform.jmir.org/2024/1/e48007 %U https://doi.org/10.2196/48007 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e44931 %T Effect of Long-Distance Domestic Travel Ban Policies in Japan on COVID-19 Outbreak Dynamics During Dominance of the Ancestral Strain: Ex Post Facto Retrospective Observation Study %A Kurita,Junko %A Iwasaki,Yoshitaro %+ Department of Nursing, Faculty of Sports & Health Science, Daitobunka University, 560 Iwadono, Higashimatsuyama-shi, 3558501, Japan, 81 0493 31 1503, kuritaj@ic.daito.ac.jp %K airport users %K COVID-19 %K effective reproduction number %K Go To Travel campaign %K hotel visitors %K mobility %K long-distance travel %K infection control %K lockdown %K travelling %K travel %K pandemic %D 2024 %7 22.4.2024 %9 Original Paper %J Online J Public Health Inform %G English %X Background: In Japan, long-distance domestic travel was banned while the ancestral SARS-CoV-2 strain was dominant under the first declared state of emergency from March 2020 until the end of May 2020. Subsequently, the “Go To Travel” campaign travel subsidy policy was activated, allowing long-distance domestic travel, until the second state of emergency as of January 7, 2021. The effects of this long-distance domestic travel ban on SARS-CoV-2 infectivity have not been adequately evaluated. Objective: We evaluated the effects of the long-distance domestic travel ban in Japan on SARS-CoV-2 infectivity, considering climate conditions, mobility, and countermeasures such as the “Go To Travel” campaign and emergency status. Methods: We calculated the effective reproduction number R(t), representing infectivity, using the epidemic curve in Kagoshima prefecture based on the empirical distribution of the incubation period and procedurally delayed reporting from an earlier study. Kagoshima prefecture, in southern Japan, has several resorts, with an airport commonly used for transportation to Tokyo or Osaka. We regressed R(t) on the number of long-distance domestic travelers (based on the number of airport limousine bus users provided by the operating company), temperature, humidity, mobility, and countermeasures such as state of emergency declarations and the “Go To Travel” campaign in Kagoshima. The study period was June 20, 2020, through February 2021, before variant strains became dominant. A second state of emergency was not declared in Kagoshima prefecture but was declared in major cities such as Tokyo and Osaka. Results: Estimation results indicated a pattern of declining infectivity with reduced long-distance domestic travel volumes as measured by the number of airport limousine bus users. Moreover, infectivity was lower during the “Go To Travel” campaign and the second state of emergency. Regarding mobility, going to restaurants, shopping malls, and amusement venues was associated with increased infectivity. However, going to grocery stores and pharmacies was associated with decreased infectivity. Climate conditions showed no significant association with infectivity patterns. Conclusions: The results of this retrospective analysis suggest that the volume of long-distance domestic travel might reduce SARS-CoV-2 infectivity. Infectivity was lower during the “Go To Travel” campaign period, during which long-distance domestic travel was promoted, compared to that outside this campaign period. These findings suggest that policies banning long-distance domestic travel had little legitimacy or rationale. Long-distance domestic travel with appropriate infection control measures might not increase SARS-CoV-2 infectivity in tourist areas. Even though this analysis was performed much later than the study period, if we had performed this study focusing on the period of April or May 2021, it would likely yield the same results. These findings might be helpful for government decision-making in considering restarting a “Go To Travel” campaign in light of evidence-based policy. %M 38648635 %R 10.2196/44931 %U https://ojphi.jmir.org/2024/1/e44931 %U https://doi.org/10.2196/44931 %U http://www.ncbi.nlm.nih.gov/pubmed/38648635 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53837 %T Investigating SARS-CoV-2 Incidence and Morbidity in Ponce, Puerto Rico: Protocol and Baseline Results From a Community Cohort Study %A Major,Chelsea G %A Rodríguez,Dania M %A Sánchez-González,Liliana %A Rodríguez-Estrada,Vanessa %A Morales-Ortíz,Tatiana %A Torres,Carolina %A Pérez-Rodríguez,Nicole M %A Medina-Lópes,Nicole A %A Alexander,Neal %A Mabey,David %A Ryff,Kyle %A Tosado-Acevedo,Rafael %A Muñoz-Jordán,Jorge %A Adams,Laura E %A Rivera-Amill,Vanessa %A Rolfes,Melissa %A Paz-Bailey,Gabriela %+ Division of Vector Borne Diseases, Centers for Disease Control and Prevention, 1324 Calle Cañada, San Juan, 00920, Puerto Rico, 1 787 706 2254, lhi5@cdc.gov %K cohort studies %K COVID-19 %K epidemiologic studies %K Hispanic or Latino %K incidence %K prospective studies %K research methodology %K SARS-CoV-2 %K seroprevalence %D 2024 %7 19.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: A better understanding of SARS-CoV-2 infection risk among Hispanic and Latino populations and in low-resource settings in the United States is needed to inform control efforts and strategies to improve health equity. Puerto Rico has a high poverty rate and other population characteristics associated with increased vulnerability to COVID-19, and there are limited data to date to determine community incidence. Objective: This study describes the protocol and baseline seroprevalence of SARS-CoV-2 in a prospective community-based cohort study (COPA COVID-19 [COCOVID] study) to investigate SARS-CoV-2 infection incidence and morbidity in Ponce, Puerto Rico. Methods: In June 2020, we implemented the COCOVID study within the Communities Organized to Prevent Arboviruses project platform among residents of 15 communities in Ponce, Puerto Rico, aged 1 year or older. Weekly, participants answered questionnaires on acute symptoms and preventive behaviors and provided anterior nasal swab samples for SARS-CoV-2 polymerase chain reaction testing; additional anterior nasal swabs were collected for expedited polymerase chain reaction testing from participants that reported 1 or more COVID-19–like symptoms. At enrollment and every 6 months during follow-up, participants answered more comprehensive questionnaires and provided venous blood samples for multiantigen SARS-CoV-2 immunoglobulin G antibody testing (an indicator of seroprevalence). Weekly follow-up activities concluded in April 2022 and 6-month follow-up visits concluded in August 2022. Primary study outcome measures include SARS-CoV-2 infection incidence and seroprevalence, relative risk of SARS-CoV-2 infection by participant characteristics, SARS-CoV-2 household attack rate, and COVID-19 illness characteristics and outcomes. In this study, we describe the characteristics of COCOVID participants overall and by SARS-CoV-2 seroprevalence status at baseline. Results: We enrolled a total of 1030 participants from 388 households. Relative to the general populations of Ponce and Puerto Rico, our cohort overrepresented middle-income households, employed and middle-aged adults, and older children (P<.001). Almost all participants (1021/1025, 99.61%) identified as Latino/a, 17.07% (175/1025) had annual household incomes less than US $10,000, and 45.66% (463/1014) reported 1 or more chronic medical conditions. Baseline SARS-CoV-2 seroprevalence was low (16/1030, 1.55%) overall and increased significantly with later study enrollment time (P=.003). Conclusions: The COCOVID study will provide a valuable opportunity to better estimate the burden of SARS-CoV-2 and associated risk factors in a primarily Hispanic or Latino population, assess the limitations of surveillance, and inform mitigation measures in Puerto Rico and other similar populations. International Registered Report Identifier (IRRID): RR1-10.2196/53837 %M 38640475 %R 10.2196/53837 %U https://www.researchprotocols.org/2024/1/e53837 %U https://doi.org/10.2196/53837 %U http://www.ncbi.nlm.nih.gov/pubmed/38640475 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e38170 %T Comparing Contact Tracing Through Bluetooth and GPS Surveillance Data: Simulation-Driven Approach %A Qian,Weicheng %A Cooke,Aranock %A Stanley,Kevin Gordon %A Osgood,Nathaniel David %+ Department of Computer Science, University of Saskatchewan, 110 Science Place, Saskatoon, SK, S7N 5C9, Canada, 1 3069661947, weicheng.qian@usask.ca %K smartphone-based sensing %K proximity contact data %K transmission models %K agent-based simulation %K health informatics %K mobile phone %D 2024 %7 17.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Accurate and responsive epidemiological simulations of epidemic outbreaks inform decision-making to mitigate the impact of pandemics. These simulations must be grounded in quantities derived from measurements, among which the parameters associated with contacts between individuals are notoriously difficult to estimate. Digital contact tracing data, such as those provided by Bluetooth beaconing or GPS colocating, can provide more precise measures of contact than traditional methods based on direct observation or self-reporting. Both measurement modalities have shortcomings and are prone to false positives or negatives, as unmeasured environmental influences bias the data. Objective: We aim to compare GPS colocated versus Bluetooth beacon–derived proximity contact data for their impacts on transmission models’ results under community and types of diseases. Methods: We examined the contact patterns derived from 3 data sets collected in 2016, with participants comprising students and staff from the University of Saskatchewan in Canada. Each of these 3 data sets used both Bluetooth beaconing and GPS localization on smartphones running the Ethica Data (Avicenna Research) app to collect sensor data about every 5 minutes over a month. We compared the structure of contact networks inferred from proximity contact data collected with the modalities of GPS colocating and Bluetooth beaconing. We assessed the impact of sensing modalities on the simulation results of transmission models informed by proximate contacts derived from sensing data. Specifically, we compared the incidence number, attack rate, and individual infection risks across simulation results of agent-based susceptible-exposed-infectious-removed transmission models of 4 different contagious diseases. We have demonstrated their differences with violin plots, 2-tailed t tests, and Kullback-Leibler divergence. Results: Both network structure analyses show visually salient differences in proximity contact data collected between GPS colocating and Bluetooth beaconing, regardless of the underlying population. Significant differences were found for the estimated attack rate based on distance threshold, measurement modality, and simulated disease. This finding demonstrates that the sensor modality used to trace contact can have a significant impact on the expected propagation of a disease through a population. The violin plots of attack rate and Kullback-Leibler divergence of individual infection risks demonstrated discernible differences for different sensing modalities, regardless of the underlying population and diseases. The results of the t tests on attack rate between different sensing modalities were mostly significant (P<.001). Conclusions: We show that the contact networks generated from these 2 measurement modalities are different and generate significantly different attack rates across multiple data sets and pathogens. While both modalities offer higher-resolution portraits of contact behavior than is possible with most traditional contact measures, the differential impact of measurement modality on the simulation outcome cannot be ignored and must be addressed in studies only using a single measure of contact in the future. %M 38422493 %R 10.2196/38170 %U https://www.jmir.org/2024/1/e38170 %U https://doi.org/10.2196/38170 %U http://www.ncbi.nlm.nih.gov/pubmed/38422493 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53417 %T Moderating Effect of Coping Strategies on the Association Between the Infodemic-Driven Overuse of Health Care Services and Cyberchondria and Anxiety: Partial Least Squares Structural Equation Modeling Study %A Xu,Richard Huan %A Chen,Caiyun %+ Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, China (Hong Kong), 852 27664199, richard.xu@polyu.edu.hk %K infodemic %K health care %K cyberchondria %K anxiety %K coping %K structural equation modeling %D 2024 %7 9.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has led to a substantial increase in health information, which has, in turn, caused a significant rise in cyberchondria and anxiety among individuals who search for web-based medical information. To cope with this information overload and safeguard their mental well-being, individuals may adopt various strategies. However, the effectiveness of these strategies in mitigating the negative effects of information overload and promoting overall well-being remains uncertain. Objective: This study aimed to investigate the moderating effect of coping strategies on the relationship between the infodemic-driven misuse of health care and depression and cyberchondria. The findings could add a new dimension to our understanding of the psychological impacts of the infodemic, especially in the context of a global health crisis, and the moderating effect of different coping strategies on the relationship between the overuse of health care and cyberchondria and anxiety. Methods: The data used in this study were obtained from a cross-sectional web-based survey. A professional survey company was contracted to collect the data using its web-based panel. The survey was completed by Chinese individuals aged 18 years or older without cognitive problems. Model parameters of the relationships between infodemic-driven overuse of health care, cyberchondria, and anxiety were analyzed using bootstrapped partial least squares structural equation modeling. Additionally, the moderating effects of coping strategies on the aforementioned relationships were also examined. Results: A total of 986 respondents completed the web-based survey. The mean scores of the Generalized Anxiety Disorder-7 and Cyberchondria Severity Scale-12 were 8.4 (SD 3.8) and 39.7 (SD 7.5), respectively. The mean score of problem-focused coping was higher than those of emotion- and avoidant-focused coping. There was a significantly positive relationship between a high level of infodemic and increased overuse of health care (bootstrapped mean 0.21, SD 0.03; 95% CI 0.1581-0.271). The overuse of health care resulted in more severe cyberchondria (bootstrapped mean 0.107, SD 0.032) and higher anxiety levels (bootstrapped mean 0.282, SD 0.032) in all the models. Emotion (bootstrapped mean 0.02, SD 0.008 and 0.037, SD 0.015)- and avoidant (bootstrapped mean 0.026, SD 0.009 and 0.049, SD 0.016)-focused coping strategies significantly moderated the relationship between the overuse of health care and cyberchondria and that between the overuse of health care and anxiety, respectively. Regarding the problem-based model, the moderating effect was significant for the relationship between the overuse of health care and anxiety (bootstrapped mean 0.007, SD 0.011; 95% CI 0.005-0.027). Conclusions: This study provides empirical evidence about the impact of coping strategies on the relationship between infodemic-related overuse of health care services and cyberchondria and anxiety. Future research can build on the findings of this study to further explore these relationships and develop and test interventions aimed at mitigating the negative impact of the infodemic on mental health. %M 38593427 %R 10.2196/53417 %U https://www.jmir.org/2024/1/e53417 %U https://doi.org/10.2196/53417 %U http://www.ncbi.nlm.nih.gov/pubmed/38593427 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e49527 %T Estimated Number of Injection-Involved Overdose Deaths in US States From 2000 to 2020: Secondary Analysis of Surveillance Data %A Hall,Eric William %A Sullivan,Patrick Sean %A Bradley,Heather %+ OHSU-PSU School of Public Health, Oregon Health and Science University, 1810 SW 5th Avenue, Suite 510, Portland, OR, 97201, United States, 1 503 494 4966, halleri@ohsu.edu %K death rate %K death %K drug abuse %K drugs %K injection drug use %K injection %K mortality %K National Vital Statistics System %K overdose death rate %K overdose %K state %K substance abuse %K Treatment Episode Dataset-Admission %K treatment %D 2024 %7 5.4.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In the United States, both drug overdose mortality and injection-involved drug overdose mortality have increased nationally over the past 25 years. Despite documented geographic differences in overdose mortality and substances implicated in overdose mortality trends, injection-involved overdose mortality has not been summarized at a subnational level. Objective: We aimed to estimate the annual number of injection-involved overdose deaths in each US state from 2000 to 2020. Methods: We conducted a stratified analysis that used data from drug treatment admissions (Treatment Episodes Data Set–Admissions; TEDS-A) and the National Vital Statistics System (NVSS) to estimate state-specific percentages of reported drug overdose deaths that were injection-involved from 2000 to 2020. TEDS-A collects data on the route of administration and the type of substance used upon treatment admission. We used these data to calculate the percentage of reported injections for each drug type by demographic group (race or ethnicity, sex, and age group), year, and state. Additionally, using NVSS mortality data, the annual number of overdose deaths involving selected drug types was identified by the following specific multiple-cause-of-death codes: heroin or synthetic opioids other than methadone (T40.1, T40.4), natural or semisynthetic opioids and methadone (T40.2, T40.3), cocaine (T40.5), psychostimulants with abuse potential (T43.6), sedatives (T42.3, T42.4), and others (T36-T59.0). We used the probabilities of injection with the annual number of overdose deaths, by year, primary substance, and demographic groups to estimate the number of overdose deaths that were injection-involved. Results: In 2020, there were 91,071 overdose deaths among adults recorded in the United States, and 93.1% (84,753/91,071) occurred in the 46 jurisdictions that reported data to TEDS-A. Slightly less than half (38,253/84,753, 45.1%; 95% CI 41.1%-49.8%) of those overdose deaths were estimated to be injection-involved, translating to 38,253 (95% CI 34,839-42,181) injection-involved overdose deaths in 2020. There was large variation among states in the estimated injection-involved overdose death rate (median 14.72, range 5.45-31.77 per 100,000 people). The national injection-involved overdose death rate increased by 323% (95% CI 255%-391%) from 2010 (3.78, 95% CI 3.33-4.31) to 2020 (15.97, 95% CI 14.55-17.61). States in which the estimated injection-involved overdose death rate increased faster than the national average were disproportionately concentrated in the Northeast region. Conclusions: Although overdose mortality and injection-involved overdose mortality have increased dramatically across the country, these trends have been more pronounced in some regions. A better understanding of state-level trends in injection-involved mortality can inform the prioritization of public health strategies that aim to reduce overdose mortality and prevent downstream consequences of injection drug use. %M 38578676 %R 10.2196/49527 %U https://publichealth.jmir.org/2024/1/e49527 %U https://doi.org/10.2196/49527 %U http://www.ncbi.nlm.nih.gov/pubmed/38578676 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49921 %T The Influence of Joe Wicks on Physical Activity During the COVID-19 Pandemic: Thematic, Location, and Social Network Analysis of X Data %A Ahmed,Wasim %A Aiyenitaju,Opeoluwa %A Chadwick,Simon %A Hardey,Mariann %A Fenton,Alex %+ Management School, University of Stirling, Airthrey Road, Stirling, FK9 4LA, United Kingdom, 44 1482 346311, w.ahmed@hull.ac.uk %K social media %K social network analysis %K COVID-19 %K influencers %K public health %K social network %K physical activity %K promotion %K fitness %K exercise %K workout %K Twitter %K content creation %K communication %D 2024 %7 29.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background:  Social media (SM) was essential in promoting physical activity during the COVID-19 pandemic, especially among people confined to their homes. Joe Wicks, a fitness coach, became particularly popular on SM during this time, posting daily workouts that millions of people worldwide followed. Objective:  This study aims to investigate the influence of Joe Wicks on SM and the impact of his content on physical activity levels among the public. Methods:  We used NodeXL Pro (Social Media Research Foundation) to collect data from X (formerly Twitter) over 54 days (March 23, 2020, to May 15, 2020), corresponding to the strictest lockdowns in the United Kingdom. We collected 290,649 posts, which we analyzed using social network analysis, thematic analysis, time-series analysis, and location analysis. Results:  We found that there was significant engagement with content generated by Wicks, including reposts, likes, and comments. The most common types of posts were those that contained images, videos, and text of young people (school-aged children) undertaking physical activity by watching content created by Joe Wicks and posts from schools encouraging pupils to engage with the content. Other shared posts included those that encouraged others to join the fitness classes run by Wicks and those that contained general commentary. We also found that Wicks’ network of influence was extensive and complex. It contained numerous subcommunities and resembled a broadcast network shape. Other influencers added to engagement with Wicks via their networks. Our results show that influencers can create networks of influence that are exhibited in distinctive ways. Conclusions: Our study found that Joe Wicks was a highly influential figure on SM during the COVID-19 pandemic and that his content positively impacted physical activity levels among the public. Our findings suggest that influencers can play an important role in promoting public health and that government officials should consider working with influencers to communicate health messages and promote healthy behaviors. Our study has broader implications beyond the status of fitness influencers. Recognizing the critical role of individuals such as Joe Wicks in terms of health capital should be a critical area of inquiry for governments, public health authorities, and policy makers and mirrors the growing interest in health capital as part of embodied and digital experiences in everyday life. %M 38551627 %R 10.2196/49921 %U https://www.jmir.org/2024/1/e49921 %U https://doi.org/10.2196/49921 %U http://www.ncbi.nlm.nih.gov/pubmed/38551627 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48130 %T Medical Misinformation in Polish on the World Wide Web During the COVID-19 Pandemic Period: Infodemiology Study %A Chlabicz,Małgorzata %A Nabożny,Aleksandra %A Koszelew,Jolanta %A Łaguna,Wojciech %A Szpakowicz,Anna %A Sowa,Paweł %A Budny,Wojciech %A Guziejko,Katarzyna %A Róg-Makal,Magdalena %A Pancewicz,Sławomir %A Kondrusik,Maciej %A Czupryna,Piotr %A Cudowska,Beata %A Lebensztejn,Dariusz %A Moniuszko-Malinowska,Anna %A Wierzbicki,Adam %A Kamiński,Karol A %+ Department of Software Engineering, Gdańsk University of Technology, ul. Gabriela Narutowicza 11/12, Gdańsk, 80-233, Poland, 48 58 348 67 00, alenaboz@pg.edu.pl %K infodemic %K fake news %K information credibility %K online health information %K evidence based medicine %K EBM %K false %K credibility %K credible %K health information %K online information %K information quality %K infoveillance %K infodemiology %K misinformation %K disinformation %D 2024 %7 29.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Although researchers extensively study the rapid generation and spread of misinformation about the novel coronavirus during the pandemic, numerous other health-related topics are contaminating the internet with misinformation that have not received as much attention. Objective: This study aims to gauge the reach of the most popular medical content on the World Wide Web, extending beyond the confines of the pandemic. We conducted evaluations of subject matter and credibility for the years 2021 and 2022, following the principles of evidence-based medicine with assessments performed by experienced clinicians. Methods: We used 274 keywords to conduct web page searches through the BuzzSumo Enterprise Application. These keywords were chosen based on medical topics derived from surveys administered to medical practitioners. The search parameters were confined to 2 distinct date ranges: (1) January 1, 2021, to December 31, 2021; (2) January 1, 2022, to December 31, 2022. Our searches were specifically limited to web pages in the Polish language and filtered by the specified date ranges. The analysis encompassed 161 web pages retrieved in 2021 and 105 retrieved in 2022. Each web page underwent scrutiny by a seasoned doctor to assess its credibility, aligning with evidence-based medicine standards. Furthermore, we gathered data on social media engagements associated with the web pages, considering platforms such as Facebook, Pinterest, Reddit, and Twitter. Results: In 2022, the prevalence of unreliable information related to COVID-19 saw a noteworthy decline compared to 2021. Specifically, the percentage of noncredible web pages discussing COVID-19 and general vaccinations decreased from 57% (43/76) to 24% (6/25) and 42% (10/25) to 30% (3/10), respectively. However, during the same period, there was a considerable uptick in the dissemination of untrustworthy content on social media pertaining to other medical topics. The percentage of noncredible web pages covering cholesterol, statins, and cardiology rose from 11% (3/28) to 26% (9/35) and from 18% (5/28) to 26% (6/23), respectively. Conclusions: Efforts undertaken during the COVID-19 pandemic to curb the dissemination of misinformation seem to have yielded positive results. Nevertheless, our analysis suggests that these interventions need to be consistently implemented across both established and emerging medical subjects. It appears that as interest in the pandemic waned, other topics gained prominence, essentially “filling the vacuum” and necessitating ongoing measures to address misinformation across a broader spectrum of health-related subjects. %M 38551638 %R 10.2196/48130 %U https://www.jmir.org/2024/1/e48130 %U https://doi.org/10.2196/48130 %U http://www.ncbi.nlm.nih.gov/pubmed/38551638 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57280 %T The Feasibility of Using the National PulsePoint Cardiopulmonary Resuscitation Responder Network to Facilitate Overdose Education and Naloxone Distribution: Protocol for a Randomized Controlled Trial %A Agley,Jon %A Henderson,Cris %A Seo,Dong-Chul %A Parker,Maria %A Golzarri-Arroyo,Lilian %A Dickinson,Stephanie %A Tidd,David %+ Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, 809 E. 9th St., Bloomington, IN, 47405, United States, 1 812 855 3123, jagley@indiana.edu %K naloxone %K PulsePoint %K randomized controlled trial %K RCT %K first responder %K overdose %K community engagement %K citizen mobilization %K opioids %K Narcan %K mobile phone %D 2024 %7 29.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The use of naloxone, an opioid antagonist, is a critical component of the US response to fatal opioid-involved overdoses. The importance and utility of naloxone in preventing fatal overdoses have been widely declaimed by medical associations and government officials and are supported by strong research evidence. Still, there are gaps in the current US national strategy because many opioid-involved overdose fatalities have no evidence of naloxone administration. Improving the likelihood that naloxone will be used to prevent fatal overdoses is predicated on facilitating an environment wherein naloxone is available near each overdose and can be accessed by someone who is willing and able to use it. How to accomplish this on a national scale has been unclear. However, there exists a national network of >1 million cardiopulmonary resuscitation (CPR) layperson responders and 4800 emergency responder agencies linked through a mobile phone app called PulsePoint Respond. PulsePoint responders certify that they are trained to administer CPR and are willing to respond to possible cardiac events in public. When such an event occurs near their mobile phone’s location, they receive an alert to respond. These motivated citizens are ideally positioned to carry naloxone and reverse overdoses that occur in public. Objective: This randomized controlled trial will examine the feasibility of recruiting first responder agencies and layperson CPR responders who already use PulsePoint to obtain overdose education and carry naloxone. Methods: This will be a 3-arm parallel-group randomized controlled trial. We will randomly select 180 first responder agencies from the population of agencies contracting with the PulsePoint Foundation. The 3 study arms will include a standard recruitment arm, a misperception-correction recruitment arm, and a control arm (1:1:1 allocation, with random allocation stratified by zip code designation [rural or nonrural]). We will study agency recruitment and, among the agencies we successfully recruit, responder certification of receiving overdose and naloxone education, carrying naloxone, or both. Hypothesis 1 contrasts agency recruitment success between arms 1 and 2, and hypothesis 2 contrasts the ratios of layperson certification across all 3 arms. The primary analyses will be a logistic regression comparing the recruitment rates among the arms, adjusting for rural or nonrural zip code designation. Results: This study was reviewed by the Indiana University Institutional Review Board (20218 and 20219). This project was funded beginning September 14, 2023, by the National Institute on Drug Abuse. Conclusions: The hypotheses in this study will test whether a specific type of messaging is particularly effective in recruiting agencies and layperson responders. Although we hypothesize that arm 2 will outperform the other arms, our intention is to use the best-performing approach in the next phase of this study if any of our approaches demonstrates feasibility. Trial Registration: OSF Registries osf.io/egn3z; https://osf.io/egn3z International Registered Report Identifier (IRRID): PRR1-10.2196/57280 %M 38551636 %R 10.2196/57280 %U https://www.researchprotocols.org/2024/1/e57280 %U https://doi.org/10.2196/57280 %U http://www.ncbi.nlm.nih.gov/pubmed/38551636 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e43585 %T Influence of Environmental Factors and Genome Diversity on Cumulative COVID-19 Cases in the Highland Region of China: Comparative Correlational Study %A Deji,Zhuoga %A Tong,Yuantao %A Huang,Honglian %A Zhang,Zeyu %A Fang,Meng %A Crabbe,M James C %A Zhang,Xiaoyan %A Wang,Ying %+ Department of Clinical Laboratory Medicine Center, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Rd, Shanghai, 200437, China, 86 021 65161782, nadger_wang@139.com %K COVID-19 %K environmental factors %K altitude %K population density %K virus mutation %D 2024 %7 25.3.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: The novel coronavirus SARS-CoV-2 caused the global COVID-19 pandemic. Emerging reports support lower mortality and reduced case numbers in highland areas; however, comparative studies on the cumulative impact of environmental factors and viral genetic diversity on COVID-19 infection rates have not been performed to date. Objective: The aims of this study were to determine the difference in COVID-19 infection rates between high and low altitudes, and to explore whether the difference in the pandemic trend in the high-altitude region of China compared to that of the lowlands is influenced by environmental factors, population density, and biological mechanisms. Methods: We examined the correlation between population density and COVID-19 cases through linear regression. A zero-shot model was applied to identify possible factors correlated to COVID-19 infection. We further analyzed the correlation of meteorological and air quality factors with infection cases using the Spearman correlation coefficient. Mixed-effects multiple linear regression was applied to evaluate the associations between selected factors and COVID-19 cases adjusting for covariates. Lastly, the relationship between environmental factors and mutation frequency was evaluated using the same correlation techniques mentioned above. Results: Among the 24,826 confirmed COVID-19 cases reported from 40 cities in China from January 23, 2020, to July 7, 2022, 98.4% (n=24,430) were found in the lowlands. Population density was positively correlated with COVID-19 cases in all regions (ρ=0.641, P=.003). In high-altitude areas, the number of COVID-19 cases was negatively associated with temperature, sunlight hours, and UV index (P=.003, P=.001, and P=.009, respectively) and was positively associated with wind speed (ρ=0.388, P<.001), whereas no correlation was found between meteorological factors and COVID-19 cases in the lowlands. After controlling for covariates, the mixed-effects model also showed positive associations of fine particulate matter (PM2.5) and carbon monoxide (CO) with COVID-19 cases (P=.002 and P<.001, respectively). Sequence variant analysis showed lower genetic diversity among nucleotides for each SARS-CoV-2 genome (P<.001) and three open reading frames (P<.001) in high altitudes compared to 300 sequences analyzed from low altitudes. Moreover, the frequencies of 44 nonsynonymous mutations and 32 synonymous mutations were significantly different between the high- and low-altitude groups (P<.001, mutation frequency>0.1). Key nonsynonymous mutations showed positive correlations with altitude, wind speed, and air pressure and showed negative correlations with temperature, UV index, and sunlight hours. Conclusions: By comparison with the lowlands, the number of confirmed COVID-19 cases was substantially lower in high-altitude regions of China, and the population density, temperature, sunlight hours, UV index, wind speed, PM2.5, and CO influenced the cumulative pandemic trend in the highlands. The identified influence of environmental factors on SARS-CoV-2 sequence variants adds knowledge of the impact of altitude on COVID-19 infection, offering novel suggestions for preventive intervention. %M 38526532 %R 10.2196/43585 %U https://www.i-jmr.org/2024/1/e43585 %U https://doi.org/10.2196/43585 %U http://www.ncbi.nlm.nih.gov/pubmed/38526532 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54680 %T Factors Underlying Vaccine Hesitancy and Their Mitigations in Saudi Arabia: Protocol for a Systematic Review %A Kanan,Mohammed %A Abdulrahman,Samar %A Alshehri,Abdulaziz %A AlSuhaibani,Renad %A Alotaibi,Nawaf M %A Alsaleh,Azhar %A Nasser,Bushra %A Baowaydhan,Rana %A Alredaini,Ibrahim %A Khalid,Taif %A Almukhtar,Fatima %A Altoaimi,Nourah %A Alhneshel,Almaha %A Alanazi,Shouq %A Algmaizi,Shahad %+ Department of Clinical Pharmacy, King Fahad Medical City, 2642, Makkah Al Mukarramah Br Rd, As Sulimaniyah, Riyadh, 12231, Saudi Arabia, 966 508564504, ii_kanan101@outlook.com %K acceptance %K campaigns %K effectiveness %K factors %K hesitancy %K immunization rates %K immunization %K intervention %K literature analysis %K misinformation %K mitigations %K prevention %K protocol %K public health %K review methodology %K review methods %K Saudi Arabia %K search %K searching %K syntheses %K synthesis %K systematic review %K systematic %K vaccination %K vaccine hesitancy %K vaccine %D 2024 %7 22.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Vaccine hesitancy is a growing concern in Saudi Arabia, impacting even well-educated parents. The decision-making process involves various factors such as accessibility, trustworthy information, and the influence of social networks, reflecting a complex interplay of emotional, cultural, social, spiritual, and political dimensions. Objective: This review seeks to evaluate the prevalence and trends of vaccine hesitancy, identify contributing factors, and explore potential solutions to enhance immunization rates. This review aligns with global concerns, as the World Health Organization has identified vaccine hesitancy as a top global health threat. Methods: Our systematic review will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and PICOS (Population, Intervention, Comparison, Outcomes, and Study) criteria for comprehensive assessment. We will conduct a thorough search across various databases, encompassing a wide range of vaccines, and pay special attention to vaccination campaigns and refusals. Inclusion criteria involve descriptive, observational, and analytical studies focusing on factors influencing vaccine acceptance or hesitancy. The study will use the Crowe Critical Appraisal Tool for quality assessment and perform a narrative synthesis to summarize findings thematically. Results: This systematic review is expected to unveil the prevalence and trends of vaccine hesitancy in diverse populations in Saudi Arabia, shedding light on cultural, religious, and social factors contributing to hesitancy. It aims to assess the effectiveness of implemented strategies, enable regional and global comparisons, and provide implications for tailored vaccination policies. Additionally, the review may pinpoint research gaps, guiding future investigations to address and mitigate vaccine hesitancy effectively. Conclusions: The findings are expected to have direct policy implications and guide interventions to strengthen vaccination programs and improve public health outcomes. International Registered Report Identifier (IRRID): PRR1-10.2196/54680 %M 38517463 %R 10.2196/54680 %U https://www.researchprotocols.org/2024/1/e54680 %U https://doi.org/10.2196/54680 %U http://www.ncbi.nlm.nih.gov/pubmed/38517463 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e46591 %T Association Between Long‑Term Exposure to Air Pollution and the Rate of Mortality After Hip Fracture Surgery in Patients Older Than 60 Years: Nationwide Cohort Study in Taiwan %A Chuang,Shu-Han %A Kuo,Yi-Jie %A Huang,Shu-Wei %A Zhang,Han-Wei %A Peng,Hsiao-Ching %A Chen,Yu-Pin %+ Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, No. 111, Sec. 3, Xinglong Rd, Wenshan District, Taipei City, 116079, Taiwan, 886 933296411, 99231@w.tmu.edu.tw %K air pollution %K hip fracture %K mortality %K exposure %K older adult %K environmental hazard %K hazard %K morbidity %D 2024 %7 18.3.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: To enhance postoperative patient survival, particularly in older adults, understanding the predictors of mortality following hip fracture becomes paramount. Air pollution, a prominent global environmental issue, has been linked to heightened morbidity and mortality across a spectrum of diseases. Nevertheless, the precise impact of air pollution on hip fracture outcomes remains elusive. Objective: This retrospective study aims to comprehensively investigate the profound influence of a decade-long exposure to 12 diverse air pollutants on the risk of post–hip fracture mortality among older Taiwanese patients (older than 60 years). We hypothesized that enduring long-term exposure to air pollution would significantly elevate the 1-year mortality rate following hip fracture surgery. Methods: From Taiwan’s National Health Insurance Research Database, we obtained the data of patients who underwent hip fracture surgery between July 1, 2003, and December 31, 2013. Using patients’ insurance registration data, we estimated their cumulative exposure levels to sulfur dioxide (SO2), carbon dioxide (CO2), carbon monoxide (CO), ozone (O3), particulate matter having a size of <10 μm (PM10), particulate matter having a size of <2.5 μm (PM2.5), nitrogen oxides (NOX), nitrogen monoxide (NO), nitrogen dioxide (NO2), total hydrocarbons (THC), nonmethane hydrocarbons (NMHC), and methane (CH4). We quantified the dose-response relationship between these air pollutants and the risk of mortality by calculating hazard ratios associated with a 1 SD increase in exposure levels over a decade. Results: Long-term exposure to SO2, CO, PM10, PM2.5, NOX, NO, NO2, THC, NMHC, and CH4 demonstrated significant associations with heightened all-cause mortality risk within 1 year post hip fracture surgery among older adults. For older adults, each 1 SD increment in the average exposure levels of SO2, CO, PM10, PM2.5, NOX, NO, NO2, THC, NMHC, and CH4 corresponded to a substantial escalation in mortality risk, with increments of 14%, 49%, 18%, 12%, 41%, 33%, 38%, 20%, 9%, and 26%, respectively. We further noted a 35% reduction in the hazard ratio for O3 exposure suggesting a potential protective effect, along with a trend of potentially protective effects of CO2. Conclusions: This comprehensive nationwide retrospective study, grounded in a population-based approach, demonstrated that long-term exposure to specific air pollutants significantly increased the risk of all-cause mortality within 1 year after hip fracture surgery in older Taiwanese adults. A reduction in the levels of SO2, CO, PM10, PM2.5, NOX, NO, NO2, THC, NMHC, and CH4 may reduce the risk of mortality after hip fracture surgery. This study provides robust evidence and highlights the substantial impact of air pollution on the outcomes of hip fractures. %M 38342504 %R 10.2196/46591 %U https://publichealth.jmir.org/2024/1/e46591 %U https://doi.org/10.2196/46591 %U http://www.ncbi.nlm.nih.gov/pubmed/38342504 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e49772 %T Association Between Physical Activity and the Risk of Burnout in Health Care Workers: Systematic Review %A Mincarone,Pierpaolo %A Bodini,Antonella %A Tumolo,Maria Rosaria %A Sabina,Saverio %A Colella,Riccardo %A Mannini,Linda %A Sabato,Eugenio %A Leo,Carlo Giacomo %+ Biological and Environmental Sciences and Technology Department, University of Salento, Strada per Monteroni, Lecce, 73100, Italy, 1 3890118275, mariarosaria.tumolo@unisalento.it %K burnout %K Maslach Burnout Inventory %K MBI %K Copenhagen Burnout Inventory %K CBI %K Professional Fulfillment Index %K PFI %K physical activity %K health care workers %K public health policy %D 2024 %7 18.3.2024 %9 Review %J JMIR Public Health Surveill %G English %X Background: Burnout is a multidimensional psychological syndrome that arises from chronic workplace stress. Health care workers (HCWs), who operate in physically and emotionally exhausting work contexts, constitute a vulnerable group. This, coupled with its subsequent impact on patients and public economic resources, makes burnout a significant public health concern. Various self-care practices have been suggested to have a positive effect on burnout among HCWs. Of these, physical activity stands out for its ability to combine psychological, physiological, and biochemical mechanisms. In fact, it promotes psychological detachment from work and increases self-efficacy by inhibiting neurotransmitters and neuromodulators, increasing endorphin levels, enhancing mitochondrial function, and attenuating the hypothalamic pituitary-adrenal axis response to stress. Objective: Our objective was to conduct a systematic review of the evidence on the association between physical activity and burnout among HCWs. Methods: We considered HCWs, physical activity, and burnout, framing them as population, exposure, and outcome, respectively. We searched APA PsycArticles, MEDLINE, and Scopus until July 2022. We extracted relevant data on study design, methods to measure exposure and outcome, and statistical approaches. Results: Our analysis encompassed 21 independent studies. Although 10% (2/21) of the studies explicitly focused on physical activity, the remaining investigations were exploratory in nature and examined various predictors, including physical activity. The most commonly used questionnaire was the Maslach Burnout Inventory. Owing to the heterogeneity in definitions and cutoffs used, the reported prevalence of burnout varied widely, ranging from 7% to 83%. Heterogeneity was also observed in the measurement tools used to assess physical activity, with objective measures rarely used. In total, 14% (3/21) of the studies used structured questionnaires to assess different types of exercise, whereas most studies (18/21, 86%) only recorded the attainment of a benchmark or reported the frequency, intensity, or duration of exercise. The reported prevalence of physically active HCWs ranged from 44% to 87%. The analyses, through a variety of inferential approaches, indicated that physical activity is often associated with a reduced risk of burnout, particularly in the domains of emotional exhaustion and depersonalization. Furthermore, we compiled and classified a list of factors associated with burnout. Conclusions: Our comprehensive overview of studies investigating the association between physical activity and burnout in HCWs revealed significant heterogeneity in definitions, measurements, and analyses adopted in the literature. To address this issue, it is crucial to adopt a clear definition of physical activity and make thoughtful choices regarding measurement tools and methodologies for data analysis. Our considerations regarding the measurement of burnout and the comprehensive list of associated factors have the potential to improve future studies aimed at informing decision-makers, thus laying the foundation for more effective management measures to address burnout. %M 38498040 %R 10.2196/49772 %U https://publichealth.jmir.org/2024/1/e49772 %U https://doi.org/10.2196/49772 %U http://www.ncbi.nlm.nih.gov/pubmed/38498040 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e46750 %T Characteristics of Hepatitis B Virus, Hepatitis C Virus, and Syphilis Coinfection in People With HIV/AIDS Contracted Through Different Sources: Retrospective Study %A Yang,Rongrong %A Yuan,Rui %A Gui,Xien %A Ke,Hengning %A Zhuang,Ke %A Hu,Hui %A Li,Ling %A Feng,Ling %A Yu,Xingxia %A Yan,Yajun %A Luo,Mingqi %+ Center for AIDS Research, Wuhan University, Donghu Road 169, Wuchang District, Hubei Province, Wuhan, 430071, China, 86 +02767812881, mingqiluo@163.com %K acquired immunodeficiency syndrome %K AIDS %K human immunodeficiency virus %K HIV %K hepatitis B virus %K HBV %K hepatitis C virus %K HCV %K syphilis %D 2024 %7 27.2.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The burden of hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis coinfections remains disproportionately high among people living with HIV/AIDS. Hubei province is located in central China, where there are distinct regional characteristics of the distribution of people living with HIV/AIDS acquired via diverse transmission routes and the AIDS epidemic itself. Objective: We aimed to estimate the magnitude of HBV, HCV, or syphilis coinfections among people living with HIV/AIDS with blood-borne transmission, which includes former paid blood donors, contaminated blood recipients, and intravenous drug users, as well as among people with sex-borne HIV transmission (including heterosexual people and men who have sex with men) and people with mother-to-child HIV transmission. Methods: From January 2010 to December 2020, people living with HIV/AIDS were tested for hepatitis B surface antigen (HBsAg), HCV antibodies, and syphilis-specific antibodies. The positive patients were further tested for HBV markers, HBV DNA, and HCV RNA, and received a rapid plasma reagin circle card test. All people living with HIV/AIDS were first divided into transmission groups (blood, sex, and mother-to-child); then, people with blood-borne HIV transmission were divided into former paid blood donors, contaminated blood recipients, and intravenous drug users, while people with sex-borne HIV transmission were divided into heterosexual people and men who have sex with men. Results: Among 6623 people living with HIV/AIDS, rates of chronic HCV infection were 80.3% (590/735) in former paid blood donors, 73.3% (247/337) in intravenous drug users, 57.1% (444/777) in contaminated blood recipients, 19.4% (21/108) in people with mother-to-child HIV transmission, 8.1% (240/2975) in heterosexual people, and 1.2% (21/1691) in men who have sex with men. Chronic HBV infection rates were similar among all people with blood-borne HIV transmission. However, compared to heterosexual people, the chronic HBV infection rate was greater in men who have sex with men (213/1691, 12.6% vs 308/2975, 10.4%; χ21=5.469; P=.02), although HBV exposure was less common (827/1691, 48.9% vs 1662/2975, 55.9%; χ21=20.982; P<.001). Interestingly, the combination of HBsAg and hepatitis B e antigen (HBeAg) was found in 11 patients with sex-borne HIV transmission, but in 0 people with blood-borne HIV transmission (11/196, 5.6% vs 0/521, 0%; χ21=29.695, P<.001). In people with sex-borne HIV transmission, the proportions of patients with a syphilis titer ≥1:16 and neurosyphilis were 8.6% (105/1227) and 7.8% (37/473), respectively, whereas these values were 0 in people with blood-borne HIV transmission. Conclusions: In people living with HIV/AIDS, HCV transmission intensity was significantly associated with specific exposure modes of blood or sexual contact. The rate of chronic HBV infection among men who have sex with men was higher than in any other population. Attention should be paid to the high prevalence of neurosyphilis in people living with HIV/AIDS who contract HIV by sexual intercourse. %M 38412004 %R 10.2196/46750 %U https://publichealth.jmir.org/2024/1/e46750 %U https://doi.org/10.2196/46750 %U http://www.ncbi.nlm.nih.gov/pubmed/38412004 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e47817 %T Behavioral Insights from Vaccine Adoption in Nigeria: Cross-Sectional Survey Findings %A Agha,Sohail %A Nsofor,Ifeanyi %A Bernard,Drew %A Francis,Sarah %A Rao,Nandan %+ Behavior Design Lab, Stanford University, 581 Capistrano Way, Stanford, CA, 94305, United States, 1 1 206 351 9346, sohailagha@gmail.com %K behavioral insights %K COVID-19 %K Nigeria %K surveys %K vaccination %D 2024 %7 26.2.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: To generate behavioral insights for the development of effective vaccination interventions, we need approaches that combine rapid and inexpensive survey data collection with instruments based on easy-to-use behavior models. This study demonstrates how an inexpensive digital survey helped identify the drivers of COVID-19 vaccination in Nigeria. Objective: This study aims to illustrate how behavioral insights can be generated through inexpensive digital surveys. Methods: We designed and conducted a cross-sectional survey with multistage sampling. Data were collected from Nigerians (aged ≥18 years) from 120 strata based on age, sex, state, and urban or rural location. Respondents were recruited via advertisements on Meta platforms (Facebook and Instagram) using the Virtual Lab open-source tool. We used a Meta Messenger chatbot for data collection; participants were compensated with 400 naira (US $0.87 cents). Data collection took 2 weeks. In total, 957 respondents completed the survey, at an advertising cost of US $1.55 per respondent. An 18-item instrument measuring core motivators, ability barriers, sociodemographic characteristics, and respondents’ vaccination status was pretested before data collection. We ran separate logistic regression models to examine the relationships between vaccine uptake and core motivators, ability barriers, and sociodemographic variables. A final model that predicted vaccine uptake included all 3 sets of variables. Results: About 56% (n=540) of respondents reported that they had received at least 1 COVID-19 vaccination. Three core motivators were positively associated with vaccine uptake: the belief that the COVID-19 vaccine promised a better life (adjusted odds ratio [aOR] 3.51, 95% CI 2.23-5.52), the belief that the vaccine would allow respondents to do more things they enjoyed (aOR 1.97, 95% CI 1.33-2.93), and respondents’ perception that their friends and family members accepted their decision to get vaccinated (aOR 1.62, 95% CI 1.06-2.48). Two ability barriers were negatively associated with vaccine uptake: cost- or income-related concerns lowered the odds of being vaccinated (aOR 0.35, 95% CI 0.24-0.50) and the lack of availability of vaccines at places respondents routinely visited also lowered their odds of being vaccinated (aOR 0.29, 95% CI 0.21-0.40). After adjusting for other variables, the perceived fear of getting COVID-19 and the hardship associated with the disease were no longer associated with vaccine uptake. Conclusions: These findings suggest that hope is more important for Nigerians than fear when it comes to vaccine adoption, enjoying life is more important than worrying about getting the disease, and approval from friends and family is more powerful than their disapproval. These findings suggest that emphasizing the benefits of leading a fuller life after being vaccinated is more likely to succeed than increasing Nigerians’ fear of COVID-19. This study identifies a very different set of factors associated with COVID-19 vaccine adoption than previous Nigerian studies. %M 38407956 %R 10.2196/47817 %U https://www.i-jmr.org/2024/1/e47817 %U https://doi.org/10.2196/47817 %U http://www.ncbi.nlm.nih.gov/pubmed/38407956 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e44726 %T Identification of Myths and Misinformation About Treatment for Opioid Use Disorder on Social Media: Infodemiology Study %A ElSherief,Mai %A Sumner,Steven %A Krishnasamy,Vikram %A Jones,Christopher %A Law,Royal %A Kacha-Ochana,Akadia %A Schieber,Lyna %A De Choudhury,Munmun %+ Khoury College of Computer Sciences, Northeastern University, 360 Huntington Ave, Boston, MA, 02115, United States, 1 (617) 373 2462, m.elsherif@northeastern.edu %K addiction treatment %K machine learning %K misinformation %K natural language processing %K opioid use disorder %K social media %K substance use %D 2024 %7 23.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Health misinformation and myths about treatment for opioid use disorder (OUD) are present on social media and contribute to challenges in preventing drug overdose deaths. However, no systematic, quantitative methodology exists to identify what types of misinformation are being shared and discussed. Objective: We developed a multistage analytic pipeline to assess social media posts from Twitter (subsequently rebranded as X), YouTube, Reddit, and Drugs-Forum for the presence of health misinformation about treatment for OUD. Methods: Our approach first used document embeddings to identify potential new statements of misinformation from known myths. These statements were grouped into themes using hierarchical agglomerative clustering, and public health experts then reviewed the results for misinformation. Results: We collected a total of 19,953,599 posts discussing opioid-related content across the aforementioned platforms. Our multistage analytic pipeline identified 7 main clusters or discussion themes. Among a high-yield data set of posts (n=303) for further public health expert review, these included discussion about potential treatments for OUD (90/303, 29.8%), the nature of addiction (68/303, 22.5%), pharmacologic properties of substances (52/303, 16.9%), injection drug use (36/303, 11.9%), pain and opioids (28/303, 9.3%), physical dependence of medications (22/303, 7.2%), and tramadol use (7/303, 2.3%). A public health expert review of the content within each cluster identified the presence of misinformation and myths beyond those used as seed myths to initialize the algorithm. Conclusions: Identifying and addressing misinformation through appropriate communication strategies could be an increasingly important component of preventing overdose deaths. To further this goal, we developed and tested an approach to aid in the identification of myths and misinformation about OUD from large-scale social media content. %M 38393772 %R 10.2196/44726 %U https://formative.jmir.org/2024/1/e44726 %U https://doi.org/10.2196/44726 %U http://www.ncbi.nlm.nih.gov/pubmed/38393772 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55930 %T Authors' Reply: Concerns About the Generalizability Associated With a South African Randomized Controlled Trial on Prenatal Mothers %A Adam,Maya %A Nguyễn,Vān Kính %+ Department of Pediatrics, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, United States, 1 6508393600, madam@stanford.edu %K maternal child health %K mHealth %K mobile health %K randomized controlled trial %K short animated storytelling %K South Africa %K video health messaging %D 2024 %7 12.2.2024 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 38345840 %R 10.2196/55930 %U https://www.jmir.org/2024/1/e55930 %U https://doi.org/10.2196/55930 %U http://www.ncbi.nlm.nih.gov/pubmed/38345840 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53861 %T Concerns About the Generalizability Associated With a South African Randomized Controlled Trial on Prenatal Mothers %A Lin,Yongjian %+ Department of Gastrointestinal and Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 22, Shuangyou Road, Qingxiu District, Nanning, 530021, China, 86 13878870525, linyongjian@stu.gxmu.edu.cn %K letter %K maternal child health %K mHealth %K mobile health %K randomized controlled trial %K short animated storytelling %K South Africa %K video health messaging %D 2024 %7 12.2.2024 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 38345847 %R 10.2196/53861 %U https://www.jmir.org/2024/1/e53861 %U https://doi.org/10.2196/53861 %U http://www.ncbi.nlm.nih.gov/pubmed/38345847 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51671 %T Public Health Dashboards in Overdose Prevention: The Rhode Island Approach to Public Health Data Literacy, Partnerships, and Action %A Yedinak,Jesse %A Krieger,Maxwell S %A Joseph,Raynald %A Levin,Stacey %A Edwards,Sarah %A Bailer,Dennis A %A Goyer,Jonathan %A Daley Ndoye,Colleen %A Schultz,Cathy %A Koziol,Jennifer %A Elmaleh,Rachael %A Hallowell,Benjamin D %A Hampson,Todd %A Duong,Ellen %A Shihipar,Abdullah %A Goedel,William C %A Marshall,Brandon DL %+ Department of Epidemiology, Brown University School of Public Health, Box G S 121-3, 121 South Main Street, 3rd Floor, Providence, RI, 02912, United States, 1 401 863 3375, jesse_yedinak@brown.edu %K community engagement %K data dashboards %K data literacy %K health literacy %K overdose %K public health communication %K public health surveillance %D 2024 %7 12.2.2024 %9 Viewpoint %J J Med Internet Res %G English %X As the field of public health rises to the demands of real-time surveillance and rapid data-sharing needs in a postpandemic world, it is time to examine our approaches to the dissemination and accessibility of such data. Distinct challenges exist when working to develop a shared public health language and narratives based on data. It requires that we assess our understanding of public health data literacy, revisit our approach to communication and engagement, and continuously evaluate our impact and relevance. Key stakeholders and cocreators are critical to this process and include people with lived experience, community organizations, governmental partners, and research institutions. In this viewpoint paper, we offer an instructive approach to the tools we used, assessed, and adapted across 3 unique overdose data dashboard projects in Rhode Island, United States. We are calling this model the “Rhode Island Approach to Public Health Data Literacy, Partnerships, and Action.” This approach reflects the iterative lessons learned about the improvement of data dashboards through collaboration and strong partnerships across community members, state agencies, and an academic research team. We will highlight key tools and approaches that are accessible and engaging and allow developers and stakeholders to self-assess their goals for their data dashboards and evaluate engagement with these tools by their desired audiences and users. %M 38345849 %R 10.2196/51671 %U https://www.jmir.org/2024/1/e51671 %U https://doi.org/10.2196/51671 %U http://www.ncbi.nlm.nih.gov/pubmed/38345849 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e44648 %T Association Between Nitrogen Dioxide Pollution and Cause-Specific Mortality in China: Cross-Sectional Time Series Study %A Zeng,Jie %A Lin,Guozhen %A Dong,Hang %A Li,Mengmeng %A Ruan,Honglian %A Yang,Jun %+ School of Public Health, Guangzhou Medical University, No. 1 Xinzao Road, Xinzao Town, Panyu District, Guangzhou, 511436, China, 86 020 37103532, yangjun_eci@jnu.edu.cn %K nitrogen dioxide %K cause-specific mortality %K stratification effect %K vulnerable subpopulations %K China %D 2024 %7 5.2.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Nitrogen dioxide (NO2) has been frequently linked to a range of diseases and associated with high rates of mortality and morbidity worldwide. However, there is limited evidence regarding the risk of NO2 on a spectrum of causes of mortality. Moreover, adjustment for potential confounders in NO2 analysis has been insufficient, and the spatial resolution of exposure assessment has been limited. Objective: This study aimed to quantitatively assess the relationship between short-term NO2 exposure and death from a range of causes by adjusting for potential confounders in Guangzhou, China, and determine the modifying effect of gender and age. Methods: A time series study was conducted on 413,703 deaths that occurred in Guangzhou during the period of 2010 to 2018. The causes of death were classified into 10 categories and 26 subcategories. We utilized a generalized additive model with quasi-Poisson regression analysis using a natural cubic splines function with lag structure of 0 to 4 days to estimate the potential lag effect of NO2 on cause-specific mortality. We estimated the percentage change in cause-specific mortality rates per 10 μg/m3 increase in NO2 levels. We stratified meteorological factors such as temperature, humidity, wind speed, and air pressure into high and low levels with the median as the critical value and analyzed the effects of NO2 on various death-causing diseases at those high and low levels. To further identify potentially vulnerable subpopulations, we analyzed groups stratified by gender and age. Results: A significant association existed between NO2 exposure and deaths from multiple causes. Each 10 μg/m3 increment in NO2 density at a lag of 0 to 4 days increased the risks of all-cause mortality by 1.73% (95% CI 1.36%-2.09%) and mortality due to nonaccidental causes, cardiovascular disease, respiratory disease, endocrine disease, and neoplasms by 1.75% (95% CI 1.38%-2.12%), 2.06% (95% CI 1.54%-2.59%), 2.32% (95% CI 1.51%-3.13%), 2.40% (95% CI 0.84%-3.98%), and 1.18% (95% CI 0.59%-1.78%), respectively. Among the 26 subcategories, mortality risk was associated with 16, including intentional self-harm, hypertensive disease, and ischemic stroke disease. Relatively higher effect estimates of NO2 on mortality existed for low levels of temperature, relative humidity, wind speed, and air pressure than with high levels, except a relatively higher effect estimate was present for endocrine disease at a high air pressure level. Most of the differences between subgroups were not statistically significant. The effect estimates for NO2 were similar by gender. There were significant differences between the age groups for mortality due to all causes, nonaccidental causes, and cardiovascular disease. Conclusions: Short-term NO2 exposure may increase the risk of mortality due to a spectrum of causes, especially in potentially vulnerable populations. These findings may be important for predicting and modifying guidelines for NO2 exposure in China. %M 38315528 %R 10.2196/44648 %U https://publichealth.jmir.org/2024/1/e44648 %U https://doi.org/10.2196/44648 %U http://www.ncbi.nlm.nih.gov/pubmed/38315528 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e43366 %T Digital Group–Based Intervention for Physical Activity Promotion Among Thai Adults During the COVID-19 Lockdown: Randomized Controlled Trial %A Pomkai,Nanthawan %A Katewongsa,Piyawat %A Chamratrithirong,Aphichat %A Tharawan,Kanokwan %A Sakulsri,Teeranong %A Samutachak,Bhubate %A Widyastari,Dyah Anantalia %A Rasri,Niramon %A Wijarn,Boonyanuch %A Wongsawat,Yodchanan %+ Institute for Population and Social Research, Mahidol University, Salaya Campus, 999 Phutthamonthon 4 Road, Nakhon Pathom, 73170, Thailand, 66 875459998, piyawat.kat@mahidol.edu %K physical activity %K digital group–based activity %K collective action %K Thai adults %K COVID-19 pandemic %K COVID-19 %K design %K model %K effectiveness %K digital %K Thailand %K behavior %D 2024 %7 31.1.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic significantly diminished the physical activity (PA) level of Thai adults belonging to Generation Y (Gen Y). As a response to the global crisis, many individuals worldwide have turned to social community platforms, recognizing their potential in promoting PA during the pandemic. Gen Y, in particular, demonstrates exceptional proficiency in using social media platforms, showcasing a remarkable aptitude for swiftly accessing new information and knowledge. However, their proclivity for reckless behavior exposes them to various health risks, potentially leading to enduring adverse health consequences. Consequently, there arises a pressing need to develop a comprehensive model aimed at elevating the PA levels among individuals belonging to Gen Y. Objective: This research aimed to examine the effectiveness of a digital group–based activity in promoting PA among Gen Y in Thailand. Methods: This was a parallel 2-arm randomized controlled trial with single-blind allocation to experimental and control groups and pre- and posttest measurements. Measurements were administered on the web and were designed for respondents to complete by themselves. The sample comprised 100 Gen Y individuals who met the inclusion criteria. Both groups were matched for background characteristics. The two 8-week intervention activities were (1) two weeks of education and (2) six weeks of motivation by target groups that set goals for PA together (using the Zoom meeting application), with a time limit and group consensus as to when the goal was to be achieved. The intervention activities were implemented one by one at specified intervals and delivered daily through health apps and the official LINE account. Results: The intervention starts from August 22 to October 16, 2021. Of the 100 participants, 20 (20%) left the study, and the remaining 80 (80%) participated in the study (40 individuals each in the experimental and control groups). After participating in the experiment, a statistically significant difference in PA was found between the 2 groups (moderate to vigorous PA; 25/40, 63%; P=.03). Participants in the intervention group collected a higher cumulative minute of moderate to vigorous PA weekly (283 minutes) than those in the control group (164 minutes), and this was statistically significant (P=.03). For the transition to the fourth stage of behavior (ie, action), the improvement in the experimental group, after participating in the trial, was statistically significant compared to that of the control group (P=.01). Conclusions: Digital group–based activity showed its effectiveness in improving the PA of Gen Y individuals in the intervention group. It created a process-based intervention activity that corresponds to the stages of behavior changes, from contemplation to action. The digital community can also connect individuals to comparable groups locally and globally. Trial Registration: Thai Clinical Trials Registry TCTR20211101005; https://www.thaiclinicaltrials.org/show/TCTR20211101005 %M 38294853 %R 10.2196/43366 %U https://www.jmir.org/2024/1/e43366 %U https://doi.org/10.2196/43366 %U http://www.ncbi.nlm.nih.gov/pubmed/38294853 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e51851 %T The Impact of the Ecosystem on Health Literacy Among Rural Communities in Protected Areas: Protocol for a Mixed Methods Study %A Abd Kadir,Nor Aziah %A Azzeri,Amirah %A Jaafar,Hafiz %A Mohd Noor,Mohd Iqbal %A Kefeli,Zurina %+ Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Bandar Baru Nilai, Negeri Sembilan, 71800, Malaysia, 60 132088543, amirah.azzeri@usim.edu.my %K ecosystem %K health literacy %K protected areas %K Net-Map %K quality of life %K rural communities %K protocol %D 2024 %7 29.1.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Protected areas are crucial for the maintenance of human health and well-being. They aim to preserve biodiversity and natural resources to secure various ecosystem services that are beneficial to human health. Their ecological characteristics can influence local health literacy. Typically, communities surrounding protected areas have limited economic opportunities due to restriction policies to protect the ecosystem, resulting in socioeconomic disparities. The local community faces obstacles in gaining access to health care facilities and health information due to these limitations. It is difficult for them to locate, comprehend, and apply information and services to make better health-related decisions for themselves and others. Objective: This study protocol examines the impact of the ecosystem on health literacy among rural communities in protected areas. Methods: This study comprises 5 phases. In phase 1, we conduct a systematic review to identify the issue of health literacy in protected areas. In phase 2, we will collect data from stakeholders in a protected area of Pahang National Park and analyze the results using Net-Map analysis. In phase 3, we will conduct a survey among the adult community in Pahang National Park related to health literacy, socioeconomic status, health expenditure, and quality of life. In phase 4, informed by the results of the survey, we will determine suitable intervention programs to improve health literacy through a focus group discussion. Finally, in phase 5, we will conduct a costing analysis to analyze which intervention program is the most cost-effective. Results: This study was funded by Universiti Sains Islam Malaysia (USIM) and strategic research partnership grants, and enrollment is ongoing. The first results are expected to be submitted for publication in 2024. Conclusions: This is one of the first studies to explore health literacy among rural communities in protected areas and will provide the first insights into the overall level of health literacy in the protected community, potential determinants, and a suitable intervention program with expected cost analysis. The results can be used to promote health literacy in other protected areas and populations. Trial Registration: International Standard Randomized Controlled Trial Number Registry ISRCTN40626062; http://tinyurl.com/4kjxuwk5 International Registered Report Identifier (IRRID): PRR1-10.2196/51851 %M 38285500 %R 10.2196/51851 %U https://www.researchprotocols.org/2024/1/e51851 %U https://doi.org/10.2196/51851 %U http://www.ncbi.nlm.nih.gov/pubmed/38285500 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e49575 %T Digital Transformation of Public Health for Noncommunicable Diseases: Narrative Viewpoint of Challenges and Opportunities %A Leal Neto,Onicio %A Von Wyl,Viktor %+ Department of Computer Science, ETH Zurich, Universitätstrasse 6, Zurich, 8092, Switzerland, 41 44 632 50 94, onicio@gmail.com %K digital public health %K artificial intelligence %K non-communicable diseases %K digital health %K surveillance %K well being %K technological advancement %K public health efficiency %K digital innovation %D 2024 %7 25.1.2024 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The recent SARS-CoV-2 pandemic underscored the effectiveness and rapid deployment of digital public health interventions, notably the digital proximity tracing apps, leveraging Bluetooth capabilities to trace and notify users about potential infection exposures. Backed by renowned organizations such as the World Health Organization and the European Union, digital proximity tracings showcased the promise of digital public health. As the world pivots from pandemic responses, it becomes imperative to address noncommunicable diseases (NCDs) that account for a vast majority of health care expenses and premature disability-adjusted life years lost. The narrative of digital transformation in the realm of NCD public health is distinct from infectious diseases. Public health, with its multifaceted approach from disciplines such as medicine, epidemiology, and psychology, focuses on promoting healthy living and choices through functions categorized as “Assessment,” “Policy Development,” “Resource Allocation,” “Assurance,” and “Access.” The power of artificial intelligence (AI) in this digital transformation is noteworthy. AI can automate repetitive tasks, facilitating health care providers to prioritize personal interactions, especially those that cannot be digitalized like emotional support. Moreover, AI presents tools for individuals to be proactive in their health management. However, the human touch remains irreplaceable; AI serves as a companion guiding through the health care landscape. Digital evolution, while revolutionary, poses its own set of challenges. Issues of equity and access are at the forefront. Vulnerable populations, whether due to economic constraints, geographical barriers, or digital illiteracy, face the threat of being marginalized further. This transformation mandates an inclusive strategy, focusing on not amplifying existing health disparities but eliminating them. Population-level digital interventions in NCD prevention demand societal agreement. Policies, like smoking bans or sugar taxes, though effective, might affect those not directly benefiting. Hence, all involved parties, from policy makers to the public, should have a balanced perspective on the advantages, risks, and expenses of these digital shifts. For a successful digital shift in public health, especially concerning NCDs, AI’s potential to enhance efficiency, effectiveness, user experience, and equity—the “quadruple aim”—is undeniable. However, it is vital that AI-driven initiatives in public health domains remain purposeful, offering improvements without compromising other objectives. The broader success of digital public health hinges on transparent benchmarks and criteria, ensuring maximum benefits without sidelining minorities or vulnerable groups. Especially in population-centric decisions, like resource allocation, AI’s ability to avoid bias is paramount. Therefore, the continuous involvement of stakeholders, including patients and minority groups, remains pivotal in the progression of AI-integrated digital public health. %M 38271097 %R 10.2196/49575 %U https://publichealth.jmir.org/2024/1/e49575 %U https://doi.org/10.2196/49575 %U http://www.ncbi.nlm.nih.gov/pubmed/38271097 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e46821 %T Assessing Global, Regional, and National Time Trends and Associated Risk Factors of the Mortality in Ischemic Heart Disease Through Global Burden of Disease 2019 Study: Population-Based Study %A Shu,Tingting %A Tang,Ming %A He,Bo %A Liu,Xiaozhu %A Han,Yu %A Liu,Chang %A Jose,Pedro A %A Wang,Hongyong %A Zhang,Qing-Wei %A Zeng,Chunyu %+ Department of Cardiology, Daping Hospital, The Third Military Medical University (Army Medical University), 10 Daping Branch Road, Yuzhong District, Chongqing, 400016, China, 86 023 68729501, chunyuzeng01@163.com %K age-period-cohort analysis %K GBD 2019 %K Global Burden of Disease 2019 study %K ischemic heart disease %K mortality %K risk factors %D 2024 %7 24.1.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Ischemic heart disease (IHD) is the leading cause of death among noncommunicable diseases worldwide, but data on current epidemiological patterns and associated risk factors are lacking. Objective: This study assessed the global, regional, and national trends in IHD mortality and attributable risks since 1990. Methods: Mortality data were obtained from the Global Burden of Disease 2019 Study. We used an age-period-cohort model to calculate longitudinal age curves (expected longitudinal age-specific rate), net drift (overall annual percentage change), and local drift (annual percentage change in each age group) from 15 to >95 years of age and estimate cohort and period effects between 1990 and 2019. Deaths from IHD attributable to each risk factor were estimated on the basis of risk exposure, relative risks, and theoretical minimum risk exposure level. Results: IHD is the leading cause of death in noncommunicable disease–related mortality (118.1/598.8, 19.7%). However, the age-standardized mortality rate for IHD decreased by 30.8% (95% CI –34.83% to –27.17%) over the past 30 years, and its net drift ranged from –2.89% (95% CI –3.07% to –2.71%) in high sociodemographic index (SDI) region to –0.24% (95% CI –0.32% to –0.16%) in low-middle–SDI region. The greatest decrease in IHD mortality occurred in the Republic of Korea (high SDI) with net drift –6.06% (95% CI –6.23% to –5.88%), followed by 5 high-SDI nations (Denmark, Norway, Estonia, the Netherlands, and Ireland) and 2 high-middle–SDI nations (Israel and Bahrain) with net drift less than –5.00%. Globally, age groups of >60 years continued to have the largest proportion of IHD-related mortality, with slightly higher mortality in male than female group. For period and birth cohort effects, the trend of rate ratios for IHD mortality declined across successive period groups from 2000 to 2004 and birth cohort groups from 1985 to 2000, with noticeable improvements in high-SDI regions. In low-SDI regions, IHD mortality significantly declined in female group but fluctuated in male group across successive periods; sex differences were greater in those born after 1945 in middle- and low-middle–SDI regions and after 1970 in low-SDI regions. Metabolic risks were the leading cause of mortality from IHD worldwide in 2019. Moreover, smoking, particulate matter pollution, and dietary risks were also important risk factors, increasingly occurring at a younger age. Diets low in whole grains and legumes were prominent dietary risks in both male and female groups, and smoking and high-sodium diet mainly affect male group. Conclusions: IHD, a major concern, needs focused health care attention, especially for older male individuals and those in low-SDI regions. Metabolic risks should be prioritized for prevention, and behavioral and environmental risks should attract more attention to decrease IHD mortality. %M 38265846 %R 10.2196/46821 %U https://publichealth.jmir.org/2024/1/e46821 %U https://doi.org/10.2196/46821 %U http://www.ncbi.nlm.nih.gov/pubmed/38265846 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53130 %T Participatory Development and Assessment of Audio-Delivered Interventions and Written Material and Their Impact on the Perception, Knowledge, and Attitudes Toward Leprosy in Nigeria: Protocol for a Cluster Randomized Controlled Trial %A Murphy-Okpala,Ngozi %A Dahiru,Tahir %A van ’t Noordende,Anna T %A Gunesch,Carolin %A Chukwu,Joseph %A Nwafor,Charles %A Abdullahi,Suleiman Hudu %A Anyaike,Chukwuma %A Okereke,Ugochinyere Angelic %A Meka,Anthony %A Eze,Chinwe %A Ezeakile,Okechukwu %A Ekeke,Ngozi %+ RedAid Nigeria, 56 Nza Street, Independence Layout, Enugu, 23401, Nigeria, 234 706 749 0052, ngozi.murphyokpala@redaid-nigeria.org %K audio health education %K community perception of leprosy %K health education %K leprosy %K Nigeria %K persons affected by leprosy %D 2024 %7 24.1.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: In Nigeria, similar to many leprosy-endemic countries, leprosy is highly stigmatized. High levels of stigma among community members as well as internalized stigma among persons affected by leprosy often result in negative psychosocial consequences for those affected. To break this vicious cycle, it is important to conduct context-specific behavioral change activities. Although written material has been successful in improving knowledge and perception, it is not suitable for populations with low educational levels. Audio-delivered interventions are likely to be more suitable for people who are illiterate. This study proposes to assess the impact of an audio-delivered intervention on the perception (knowledge, attitudes, and beliefs) of community members with regard to leprosy in Nigeria. Objective: This study aims to assess the impact of audio-delivered and written health education on the perception of leprosy. Specific objectives are to (1) investigate the perception (local beliefs, knowledge, and attitudes) of community members toward leprosy and persons affected by leprosy; (2) investigate whether there is a difference in impact on perception between participants who have received audio-delivered health education and those who have received written health education, with specific reference to gender differences and differences between rural and urban areas; and (3) assess the impact of the participatory development of the audio-delivered and written interventions on empowerment and internalized stigma of persons affected by leprosy who developed the interventions. Additionally, we will translate and cross-culturally validate 4 study instruments measuring outcomes in 2 major Nigerian languages. Methods: We will use a mixed methods, cross-sectional study design for the intervention development and a 3-arm cluster randomized controlled trial for its implementation and evaluation, comprising (1) baseline assessments of knowledge, attitudes, perceptions, and fears of community members, to develop the audio-delivered content and written material, and the self-esteem and internalized stigma of persons affected by leprosy; and (2) participatory development of the audio-delivered content and written material by persons affected by leprosy and the pilot and implementation of the interventions. This will be done among different groups (selected using cluster randomization) that will be compared (control group, audio-intervention group, and written material group) to evaluate the intervention and the impact of developing the intervention on the persons affected. Results: This study was funded in June 2022, and community member participant recruitment started in January 2023. Baseline data collection was completed by May 2023 (n=811). Participatory cocreation of the audio and written health education content began in July 2023, and the materials are currently under development. Study results are expected in September 2024. Conclusions: Study findings will contribute to developing evidence-based, context-specific behavioral change interventions, which are critical to addressing stigma in many leprosy-endemic communities where leprosy is highly stigmatized, and contribute toward global triple zero leprosy efforts. Trial Registration: Pan African Clinical Trial Registry PACTR202205543939385; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=23667 International Registered Report Identifier (IRRID): DERR1-10.2196/53130 %M 38265859 %R 10.2196/53130 %U https://www.researchprotocols.org/2024/1/e53130 %U https://doi.org/10.2196/53130 %U http://www.ncbi.nlm.nih.gov/pubmed/38265859 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50211 %T Educational Video Intervention to Improve Health Misinformation Identification on WhatsApp Among Saudi Arabian Population: Pre-Post Intervention Study %A Alsaad,Ebtihal %A AlDossary,Sharifah %+ Department of Health Informatics, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Al Haras Al Watani St, Prince Mutib Ibn Abdullah Ibn Abdulaziz Rd, Ar Rimayah, Riyadh, Riyadh, PO Box 3660/ 11481, Saudi Arabia, 966 114299999, ebtihalalsaad@gmail.com %K misinformation %K education %K WhatsApp %K intervention %K pre-postintervention design %K health literacy %K educational %K video %K videos %K consumer %K consumers %K patient education %K survey %K surveys %K web-based information %K health information %K reliability %K accuracy %K reliable %K social media %D 2024 %7 17.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Health misinformation can adversely affect individuals’ quality of life and increase the risk of mortality. People often fail to assess the content of messages before sharing them on the internet, increasing the spread of misinformation. The problem is exacerbated by the growing variety of digital information environments, especially social media, which presents as an effective platform for spreading misinformation due to its rapid information-sharing capabilities. Educational interventions have been developed to help consumers verify the validity of digital health information. However, tools designed to detect health misinformation on social media content have not been validated. Given the increased use of social media platforms, particularly WhatsApp, it is crucial to develop tools to help consumers assess the credibility of messages and detect misinformation. Objective: The main objective of this study is to develop and assess an educational tool aimed at educating consumers about detecting health misinformation on WhatsApp. The secondary objective is to assess the association between demographic factors and knowledge levels. Methods: The study used a single-arm, pre-post intervention design to evaluate the effectiveness of an educational video in improving participants’ ability to detect health-related misinformation in WhatsApp messages. In the first phase, an educational video intervention was developed and validated. In the second phase, participants were invited to complete a web-based survey that consisted of pre-evaluation questions, followed by the educational video intervention. Subsequently, they were asked to answer the same questions as the postevaluation questions. Results: The web-based survey received 485 responses. The completion rate was 99.6% (n=483). Statistically significant associations existed between knowledge level and age, gender, employment, and region of residence (P<.05). The video intervention did elicit a statistically significant change in the participants’ abilities to identify misinformation in WhatsApp messages (z=–6.887; P<.001). Viewing the video was associated with increased knowledge about the following concepts: checking the “forwarded” label (P<.001), looking for spelling and grammatical errors (P<.001), analyzing the facts (P=.03), checking links (P=.002, P=.001), and assessing the photos and videos (P<.001). There was a statistically significant difference in knowledge level before and after the intervention (P<.001). Conclusions: This study developed and evaluated the effectiveness of an educational video intervention to improve health misinformation identification on WhatsApp among the Saudi Arabian population. The results indicate that educational videos can be valuable tools for improving participants’ abilities to identify misinformation. The outcomes of this research can contribute to our understanding of what constitutes an effective tool for enhancing health misinformation awareness. Such interventions may be particularly useful in combating misinformation among Arabic-speaking populations on WhatsApp, which may ultimately improve eHealth literacy. Limiting the prevalence and impact of misinformation allows people to make better-informed health decisions. %M 38231563 %R 10.2196/50211 %U https://formative.jmir.org/2024/1/e50211 %U https://doi.org/10.2196/50211 %U http://www.ncbi.nlm.nih.gov/pubmed/38231563 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49749 %T Consumption of Health-Related Videos and Human Papillomavirus Awareness: Cross-Sectional Analyses of a US National Survey and YouTube From the Urban-Rural Context %A Garg,Ashvita %A Nyitray,Alan G %A Roberts,James R %A Shungu,Nicholas %A Ruggiero,Kenneth J %A Chandler,Jessica %A Damgacioglu,Haluk %A Zhu,Yenan %A Brownstein,Naomi C %A Sterba,Katherine R %A Deshmukh,Ashish A %A Sonawane,Kalyani %+ Medical University of South Carolina, 132 Cannon St, Charleston, SC, 29425, United States, 1 8438761100, sonawane@musc.edu %K awareness %K health awareness %K health information %K health videos %K HINTS %K HPV vaccine %K HPV %K information behavior %K information behaviors %K information seeking %K online information %K reproductive health %K rural %K sexual health %K sexually transmitted %K social media %K STD %K STI %K urban %K video %K videos %K YouTube %D 2024 %7 15.1.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Nearly 70% of Americans use the internet as their first source of information for health-related questions. Contemporary data on the consumption of web-based videos containing health information among American adults by urbanity or rurality is currently unavailable, and its link with health topic awareness, particularly for human papillomavirus (HPV), is not known. Objective: We aim to describe trends and patterns in the consumption of health-related videos on social media from an urban-rural context, examine the association between exposure to health-related videos on social media and awareness of health topics (ie, HPV and HPV vaccine), and understand public interest in HPV-related video content through search terms and engagement analytics. Methods: We conducted a cross-sectional analysis of the US Health Information National Trends Survey 6, a nationally representative survey that collects data from civilian, noninstitutionalized adults aged 18 years or older residing in the United States. Bivariable analyses were used to estimate the prevalence of consumption of health-related videos on social media among US adults overall and by urbanity or rurality. Multivariable logistic regression models were used to examine the association between the consumption of health-related videos and HPV awareness among urban and rural adults. To provide additional context on the public’s interest in HPV-specific video content, we examined search volumes (quantitative) and related query searches (qualitative) for the terms “HPV” and “HPV vaccine” on YouTube. Results: In 2022, 59.6% of US adults (152.3 million) consumed health-related videos on social media, an increase of nearly 100% from 2017 to 2022. Prevalence increased among adults living in both urban (from 31.4% in 2017 to 59.8% in 2022; P<.001) and rural (from 22.4% in 2017 to 58% in 2022; P<.001) regions. Within the urban and rural groups, consumption of health-related videos on social media was most prevalent among adults aged between 18 and 40 years and college graduates or higher-educated adults. Among both urban and rural groups, adults who consumed health-related videos had a significantly higher probability of being aware of HPV and the HPV vaccine compared with those who did not watch health videos on the internet. The term “HPV” was more frequently searched on YouTube compared with “HPV vaccine.” Individuals were most commonly searching for videos that covered content about the HPV vaccine, HPV in males, and side effects of the HPV vaccine. Conclusions: The consumption of health-related videos on social media in the United States increased dramatically between 2017 and 2022. The rise was prominent among both urban and rural adults. Watching a health-related video on social media was associated with a greater probability of being aware of HPV and the HPV vaccine. Additional research on designing and developing social media strategies is needed to increase public awareness of health topics. %M 38224476 %R 10.2196/49749 %U https://www.jmir.org/2024/1/e49749 %U https://doi.org/10.2196/49749 %U http://www.ncbi.nlm.nih.gov/pubmed/38224476 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e44606 %T Evaluating the Effectiveness of School Closure in COVID-19–Related Syndromes From Community-Based Syndromic Surveillance: Longitudinal Observational Study %A Chung,Ping-Chen %A Chen,Kevin J %A Chang,Hui-Mei %A Chan,Ta-Chien %+ Research Center for Humanities and Social Sciences, Academia Sinica, 128 Academia Road, Section 2, Taipei City, 115, Taiwan, 886 227898160, tachien@sinica.edu.tw %K school closure %K COVID-19 %K syndromic surveillance %K outpatient %K mobility %D 2023 %7 15.12.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: During the COVID-19 pandemic, a school closure policy was adopted to prevent cluster transmission in schools and subsequent household transmission. However, the effectiveness of school closure is not consistent in studies conducted in different countries. Objective: This study aimed to explore the association between school closure and the daily standardized incidence of COVID-19–related syndromes in an outpatient syndromic surveillance system. Methods: We calculated the incidence of COVID-19–related syndromes derived from a community-based syndromic surveillance system between the first week of January and the second or fourth weeks after school closure in 2021 and 2022 in Taipei City, Taiwan. The effect of school closure on the standardized incidence of COVID-19–related syndromes was evaluated by interrupted time series analysis using an autoregressive integrated moving average with a distributed lag function. The exogenous variables were changes in human mobility measured by Google COVID-19 community mobility reports. Furthermore, the models quantified the influence of different age groups and the hierarchy of medical facilities, such as clinics or community hospitals. Results: School closure was only negatively and significantly associated with the overall standardized incidence of COVID-19–related syndromes in 2021 for 2 weeks after the intervention (coefficient −1.24, 95% CI −2.40 to −0.08). However, in different age groups, school closure had a significantly negative association with the standardized incidence among people aged 13-18 years and ≥65 years for 2 weeks after the intervention in clinics in 2021. In community hospitals, school closure was significantly positively associated with the standardized incidence among people aged 19-24 years in 2021. In 2022, 2 weeks after the intervention, school closure had a significantly negative association with the standardized incidence among people aged 0-6, 7-12, and 19-24 years in community hospitals and aged >45 years in clinics. Furthermore, the standardized incidence was positively associated with movement change toward grocery and pharmacy stores in all age groups in 2022. In addition, movement changes toward residences were significantly positively associated with the standardized incidence among all age groups. Conclusions: Overall, school closure effectively suppresses COVID-19–related syndromes in students owing to the reduction of physical contact. In addition, school closure has a spillover effect on elderly people who stay at home. %M 38100192 %R 10.2196/44606 %U https://www.i-jmr.org/2023/1/e44606 %U https://doi.org/10.2196/44606 %U http://www.ncbi.nlm.nih.gov/pubmed/38100192 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e50814 %T The Use of Machine Translation for Outreach and Health Communication in Epidemiology and Public Health: Scoping Review %A Herrera-Espejel,Paula Sofia %A Rach,Stefan %+ Department Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr 30, Bremen, 28359, Germany, 49 421 218 56 841, rach@leibniz-bips.de %K machine translation %K public health %K epidemiology %K population-based %K recruitment %K outreach %K multilingual %K culturally and linguistically diverse communities %D 2023 %7 20.11.2023 %9 Review %J JMIR Public Health Surveill %G English %X Background: Culturally and linguistically diverse groups are often underrepresented in population-based research and surveillance efforts, leading to biased study results and limited generalizability. These groups, often termed “hard-to-reach,” commonly encounter language barriers in the public health (PH) outreach material and information campaigns, reducing their involvement with the information. As a result, these groups are challenged by 2 effects: the medical and health knowledge is less tailored to their needs, and at the same time, it is less accessible for to them. Modern machine translation (MT) tools might offer a cost-effective solution to PH material language accessibility problems. Objective: This scoping review aims to systematically investigate current use cases of MT specific to the fields of PH and epidemiology, with a particular interest in its use for population-based recruitment methods. Methods: PubMed, PubMed Central, Scopus, ACM Digital Library, and IEEE Xplore were searched to identify articles reporting on the use of MT in PH and epidemiological research for this PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews)–compliant scoping review. Information on communication scenarios, study designs and the principal findings of each article were mapped according to a settings approach, the World Health Organization monitoring and evaluation framework and the service readiness level framework, respectively. Results: Of the 7186 articles identified, 46 (0.64%) were included in this review, with the earliest study dating from 2009. Most of the studies (17/46, 37%) discussed the application of MT to existing PH materials, limited to one-way communication between PH officials and addressed audiences. No specific article investigated the use of MT for recruiting linguistically diverse participants to population-based studies. Regarding study designs, nearly three-quarters (34/46, 74%) of the articles provided technical assessments of MT from 1 language (mainly English) to a few others (eg, Spanish, Chinese, or French). Only a few (12/46, 26%) explored end-user attitudes (mainly of PH employees), whereas none examined the legal or ethical implications of using MT. The experiments primarily involved PH experts with language proficiencies. Overall, more than half (38/70, 54% statements) of the summarizing results presented mixed and inconclusive views on the technical readiness of MT for PH information. Conclusions: Using MT in epidemiology and PH can enhance outreach to linguistically diverse populations. The translation quality of current commercial MT solutions (eg, Google Translate and DeepL Translator) is sufficient if postediting is a mandatory step in the translation workflow. Postediting of legally or ethically sensitive material requires staff with adequate content knowledge in addition to sufficient language skills. Unsupervised MT is generally not recommended. Research on whether machine-translated texts are received differently by addressees is lacking, as well as research on MT in communication scenarios that warrant a response from the addressees. %M 37983078 %R 10.2196/50814 %U https://publichealth.jmir.org/2023/1/e50814 %U https://doi.org/10.2196/50814 %U http://www.ncbi.nlm.nih.gov/pubmed/37983078 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e50444 %T Resilience-Informed Community Violence Prevention and Community Organizing Strategies for Implementation: Protocol for a Hybrid Type 1 Implementation-Effectiveness Trial %A Blackburn,Natalie A %A Ramos,Stefany %A Dorsainvil,Michele %A Wooten,Camara %A Ridenour,Ty A %A Yaros,Anna %A Johnson-Lawrence,Vicki %A Fields-Johnson,Dana %A Khalid,Nzinga %A Graham,Phillip %+ RTI International, 3040 Cornwallis Rd, Research Triangle Park, NC, 27709, United States, 1 919 485 1466, nblackburn@rti.org %K ACEs %K community organizing %K community violence %K implementation-effectiveness trial %K resilience %D 2023 %7 7.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Community violence is a persistent and challenging public health problem. Community violence not only physically affects individuals, but also its effects reverberate to the well-being of families and entire communities. Being exposed to and experiencing violence are adverse community experiences that affect the well-being and health trajectories of both children and adults. In the United States, community violence has historically been addressed through a lens of law enforcement and policing; the impact of this approach on communities has been detrimental and often ignores the strengths and experiences of community members. As such, community-centered approaches to address violence are needed, yet the process to design, implement, and evaluate these approaches is complex. Alternatives to policing responses are increasingly being implemented. However, evidence and implementation guidance for community-level public health approaches remain limited. This study protocol seeks to address community violence through a resilience framework—Adverse Community Experiences and Resilience (ACE|R)—being implemented in a major US city and leveraging a strategy of community organizing to advance community violence prevention. Objective: The objective of this research is to understand the impact of community-level violence prevention interventions. Furthermore, we aim to describe the strategies of implementation and identify barriers to and facilitators of the approach. Methods: This study uses a hybrid type 1 effectiveness-implementation design. Part 1 of the study will assess the effectiveness of the ACE|R framework plus community organizing by measuring impacts on violence- and health-related outcomes. To do so, we plan to collect quantitative data on homicides, fatal and nonfatal shootings, hospital visits due to nonaccidental injuries, calls for service, and other violence-related data. In Part 2 of the study, to assess the implementation of ACE|R plus community organizing, we will collect process data on community engagement events, deliver community trainings on community leadership and organizing, and conduct focus groups with key partners about violence and violence prevention programs in Milwaukee. Results: This project received funding on September 1, 2020. Prospective study data collection began in the fall of 2021 and will continue through the end of 2023. Data analysis is currently underway, and the first results are expected to be submitted for publication in 2024. Conclusions: Community violence is a public health problem in need of community-centered solutions. Interventions that center community and leverage community organizing show promise in decreasing violence and increasing the well-being of community members. Methods to identify the impact of community-level interventions continue to evolve. Analysis of outcomes beyond violence-specific outcomes, including norms and community beliefs, may help better inform the short-term and proximal impacts of these community-driven approaches. Furthermore, hybrid implementation-effectiveness trials allow for the inevitable contextualization required to disseminate community interventions where communities drive the adaptations and decision-making. International Registered Report Identifier (IRRID): DERR1-10.2196/50444 %M 37934578 %R 10.2196/50444 %U https://www.researchprotocols.org/2023/1/e50444 %U https://doi.org/10.2196/50444 %U http://www.ncbi.nlm.nih.gov/pubmed/37934578 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e45197 %T Understanding Loneliness in Younger People: Review of the Opportunities and Challenges for Loneliness Interventions %A Shah,Hurmat Ali %A Househ,Mowafa %+ Hamad bin Khalifa University, Education City - Gate 8, Ar Rayyan, Doha, Qatar, 974 44547278, mhouseh@hbku.edu.qa %K health informatics %K loneliness informatics %K loneliness theory %K health effects %K loneliness interventions %K information and communication technology %K ICT-based interventions %K social-media–based interventions %K social media %K ICT %K lonely %K loneliness %K social isolation %K mental health %K psychological %D 2023 %7 2.11.2023 %9 Viewpoint %J Interact J Med Res %G English %X Loneliness affects the quality of life of people all around the world. Loneliness is also shown to be directly associated with mental health issues and is often the cause of mental health problems. It is also shown to increase the risk of heart diseases and other physical illnesses. Loneliness is studied both from the social and medical sciences perspectives. There are also interventions on the basis of health informatics, information and communication technologies (ICTs), social media, and other technological solutions. In the literature, loneliness is studied from various angles and perspectives ranging from biological to socioeconomical and through anthropological understandings of technology. From the ICT and technological sides, there are multiple reviews studying the effectiveness of intervention strategies and solutions. However, there is a lack of a comprehensive review on loneliness that engulfs the psychological, social, and technological studies of loneliness. From the perspective of loneliness informatics (ie, the application of health informatics practices and tools), it is important to understand the psychological and biological basis of loneliness. When it comes to technological interventions to fight off loneliness, the majority of interventions focus on older people. While loneliness is highest among older people, theoretical and demographical studies of loneliness give a U-shaped distribution age-wise to loneliness; that is, younger people and older people are the demographics most affected by loneliness. But the strategies and interventions designed for older people cannot be directly applied to younger people. We present the dynamics of loneliness in younger people and also provide an overview of the technological interventions for loneliness in younger people. This paper presents an approach wherein the studies carried out from the perspectives of digital health and informatics are discussed in detail. A comprehensive overview of the understanding of loneliness and the study of the overall field of tools and strategies of loneliness informatics was carried out. The need to study loneliness in younger people is addressed and particular digital solutions and interventions developed for younger people are presented. This paper can be used to overcome the challenges of technological gaps in the studies and strategies developed for loneliness. The findings of this study show that the majority of interventions and reviews are focused on older people, with ICT-based and social media–based interventions showing promise for countering the effects of loneliness. There are new technologies, such as conversational agents and robots, which are tailored to the particular needs of younger people. This literature review suggests that the digital solutions developed to overcome loneliness can benefit people, and younger people in particular, more if they are made interactive in order to retain users. %M 37917125 %R 10.2196/45197 %U https://www.i-jmr.org/2023/1/e45197 %U https://doi.org/10.2196/45197 %U http://www.ncbi.nlm.nih.gov/pubmed/37917125 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e50114 %T Burden of and Trends in Urticaria Globally, Regionally, and Nationally from 1990 to 2019: Systematic Analysis %A Liu,Xiaoli %A Cao,Yuan %A Wang,Wenhui %+ Department of Dermatology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China, 86 15611908751, wwh0608@126.com %K urticaria %K burden of disease %K prevalence %K incidence %K disability-adjusted life years %D 2023 %7 26.10.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Urticaria presents a significant global health challenge due to its sudden onset and potential for severe allergic reactions. Past data on worldwide prevalence and incidence is inconsistent due to differing study methodologies, regional differences, and evolving diagnostic criteria. Past studies have often provided broad ranges instead of specific figures, underscoring the necessity for a cohesive global perspective to inform public health strategies. Objective: We aimed to assess the global burden of urticaria using the 2019 Global Burden of Disease (GBD) study data and systematically analyze urticaria prevalence, incidence, and disability-adjusted life years (DALYs) at global, regional, and national levels, thereby informing more effective prevention and treatment strategies. Methods: We analyzed the global, regional, and national burden of urticaria from 1990 to 2019 using the 2019 GBD study coordinated by the Institute for Health Metrics and Evaluation. Estimations of urticaria prevalence, incidence, and DALYs were derived using DisMod-MR 2.1, a Bayesian meta-regression tool. The Socio-demographic Index (SDI) was used to correlate development status with health outcomes. The GBD’s division of the world into 21 regions and 204 countries and territories facilitated a comprehensive assessment. Age-standardized estimated annual percentage changes were generated for urticaria metrics to quantify temporal trends, with age standardization adjusting for potential confounding from age structure. Results: From 1990 to 2019, the global age-standardized prevalence, incidence, and DALY rates of urticaria showed marginal changes. In 2019, 65.14 million individuals were affected, with a prevalence rate of 841.88 per 100,000 population. The DALY rate was 50.39 per 100,000 population. Compared to 1990, the global age-standardized prevalence, incidence, and DALY rates saw increases of 2.92, 4.84, and 0.31 per 100,000 population, respectively. Women persistently had higher rates than men. At a regional level in 2019, low-middle SDI regions exhibited the highest age-standardized metrics, whereas high SDI regions reported the lowest. Central Europe showed the highest rates, contrasting with Western Europe’s lowest rates. Nationally, urticaria prevalence in 2019 varied dramatically, from a low of 27.1 per 100,000 population in Portugal to a high of 92.0 per 100,000 population in Nepal. India reported the most DALYs at 749,495.9, followed by China, Pakistan, and the United States. Agewise data showed higher rates in younger age groups, which diminished with age and then experienced a slight resurgence in the oldest populations. This pattern was pronounced in women and younger populations, with the largest rises seen in those aged less than 40 years and the smallest in those aged more than 70 years. Conclusions: Urticaria remains a significant global health issue, with considerable variation across regions, countries, and territories. The increased burden among women, the rising burden in younger populations, and the regional differences in disease burden call for tailored interventions and policies to tackle this emerging public health issue. %M 37883176 %R 10.2196/50114 %U https://publichealth.jmir.org/2023/1/e50114 %U https://doi.org/10.2196/50114 %U http://www.ncbi.nlm.nih.gov/pubmed/37883176 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45353 %T Analysis of Wastewater Samples to Explore Community Substance Use in the United States: Pilot Correlative and Machine Learning Study %A Severson,Marie A %A Onanong,Sathaporn %A Dolezal,Alexandra %A Bartelt-Hunt,Shannon L %A Snow,Daniel D %A McFadden,Lisa M %+ Division of Basic Biomedical Sciences, University of South Dakota, 414 E. Clark St., Vermillion, SD, 57069, United States, 1 605 658 6436, lisa.mcfadden@usd.edu %K methamphetamine %K opioids %K substance use disorder %K wastewater-based surveillance %K drug detection %K pilot study %K substance use %K detecting %K monitoring %K drugs %K surveillance %K community %D 2023 %7 26.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Substance use disorder and associated deaths have increased in the United States, but methods for detecting and monitoring substance use using rapid and unbiased techniques are lacking. Wastewater-based surveillance is a cost-effective method for monitoring community drug use. However, the examination of the results often focuses on descriptive analysis. Objective: The objective of this study was to explore community substance use in the United States by analyzing wastewater samples. Geographic differences and commonalities of substance use were explored. Methods: Wastewater was sampled across the United States (n=12). Selected drugs with misuse potential, prescriptions, and over-the-counter drugs and their metabolites were tested across geographic locations for 7 days. Methods used included wastewater assessment of substances and metabolites paired with machine learning, specifically discriminant analysis and cluster analysis, to explore similarities and differences in wastewater measures. Results: Geographic variations in the wastewater drug or metabolite levels were found. Results revealed a higher use of methamphetamine (z=–2.27, P=.02) and opioids-to-methadone ratios (oxycodone-to-methadone: z=–1.95, P=.05; hydrocodone-to-methadone: z=–1.95, P=.05) in states west of the Mississippi River compared to the east. Discriminant analysis suggested temazepam and methadone were significant predictors of geographical locations. Precision, sensitivity, specificity, and F1-scores were 0.88, 1, 0.80, and 0.93, respectively. Finally, cluster analysis revealed similarities in substance use among communities. Conclusions: These findings suggest that wastewater-based surveillance has the potential to become an effective form of surveillance for substance use. Further, advanced analytical techniques may help uncover geographical patterns and detect communities with similar needs for resources to address substance use disorders. Using automated analytics, these advanced surveillance techniques may help communities develop timely, tailored treatment and prevention efforts. %M 37883150 %R 10.2196/45353 %U https://formative.jmir.org/2023/1/e45353 %U https://doi.org/10.2196/45353 %U http://www.ncbi.nlm.nih.gov/pubmed/37883150 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e49955 %T e-Learning Evaluation Framework and Tools for Global Health and Public Health Education: Protocol for a Scoping Review %A Bahattab,Awsan %A Hanna,Michel %A Teo Voicescu,George %A Hubloue,Ives %A Della Corte,Francesco %A Ragazzoni,Luca %+ Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Via Lanino, 1, Novara, 28100, Italy, 39 3339252944, awsan.bahattab@uniupo.it %K computer-assisted instruction %K disaster medicine %K disaster %K e-learning %K educational assessment %K global health %K medical education %K public health %K evaluation %K scoping %K review methods %K review methodology %K education %K educational %D 2023 %7 24.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: There has been a significant increase in the use of e-learning for global and public health education recently, especially following the COVID-19 pandemic. e-Learning holds the potential to offer equal opportunities, overcoming barriers like physical limitations and training costs. However, its effectiveness remains debated, with institutions unprepared for the sudden shift during the pandemic. To effectively evaluate the outcomes of e-learning, a standardized and rigorous approach is necessary. However, the existing literature on this subject often lacks standardized assessment tools and theoretical foundations, leading to ambiguity in the evaluation process. Consequently, it becomes imperative to identify a clear theoretical foundation and practical approach for evaluating global and public health e-learning outcomes. Objective: This protocol for a scoping review aims to map the state of e-learning evaluation in global and public health education to determine the existing theoretical evaluation frameworks, methods, tools, and domains and the gaps in research and practice. Methods: The scoping review will be conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The initial search was performed in PubMed, Education Resource Information Center, Web of Science, and Scopus to identify peer-reviewed articles that report on the use of evaluation and assessment for e-learning training. The search strings combined the concepts of e-learning, public health, and health science education, along with evaluation and frameworks. After the initial search, a screening process will be carried out to determine the relevance of the identified studies to the research question. Data related to the characteristics of the included studies, the characteristics of the e-learning technology used in the studies, and the study outcomes will be extracted from the eligible articles. The extracted data will then undergo a structured, descriptive, quantitative, and qualitative content analysis to synthesize the information from the selected studies. Results:  Initial database searches yielded a total of 980 results. Duplicates have been removed, and title and abstract screening of the 805 remaining extracted articles are underway. Quantitative and qualitative findings from the reviewed articles will be presented to answer the study objective. Conclusions: This scoping review will provide global and public health educators with a comprehensive overview of the current state of e-learning evaluation. By identifying existing e-learning frameworks and tools, the findings will offer valuable guidance for further advancements in global and public health e-learning evaluation. The study will also enable the creation of a comprehensive, evidence-based e-learning evaluation framework and tools, which will improve the quality and accountability of global health and public health education. Ultimately, this will contribute to better health outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/49955 %M 37874640 %R 10.2196/49955 %U https://www.researchprotocols.org/2023/1/e49955 %U https://doi.org/10.2196/49955 %U http://www.ncbi.nlm.nih.gov/pubmed/37874640 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e43936 %T Consumer Willingness to Pay for Food Defense and Food Hygiene in Japan: Cross-Sectional Study %A Matsumoto,Shinya %A Kanagawa,Yoshiyuki %A Nagoshi,Kiwamu %A Akahane,Takemi %A Imamura,Tomoaki %A Akahane,Manabu %+ Department of Environmental Medicine and Public Health, Faculty of Medicine, Shimane University, Enya-cho 89-1, Izumo, 693-8501, Japan, 81 853 20 2162, smatsumo@med.shimane-u.ac.jp %K food defense %K food hygiene %K contingent valuation method %K willingness %K food %K cost %K awareness %K food safety %K questionnaire %K Japan %K prevention %K food poisoning %K safety %D 2023 %7 23.10.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: In Japan, incidents of falsified expiration dates on popular cookie brands and health hazards associated with frozen Chinese dumplings have raised food safety awareness. To prevent the intentional contamination of food by foreign substances, large food manufacturing companies have adopted the concept of food defense. Objective: The aim of this study was to assess people’s willingness to pay for food protection measures. In addition, the impact of participants’ personalities and considerations regarding their purchase choices on how much they were willing to pay when shopping for food and other products were measured. Methods: A questionnaire on willingness to pay for food hygiene and food defense was administered via a web survey and 1414 responses were included in the analysis. Univariate logistic regression analyses were performed with individuals willing and unwilling to pay additional costs as the objective variable and other questionnaire items as explanatory variables. A principal component analysis was performed on 12 questions regarding how much additional money people were willing to pay, and the principal component scores and other questions were examined for implications and other information. Results: Approximately one-third of the respondents stated that they were unwilling to pay additional costs and reported a willingness to consume delivery food even if it contained items that were not part of the original order. The first principal component reflected the extent to which people were willing to pay additional money, and if so, how much. This tendency existed even if the individual foods and amounts varied. The third principal component reflected the amount of extra money that people were willing to pay, which was determined by the amount people had to pay toward food safety measures. Those who answered “zero” were more likely to believe that consumers should not have to pay to ensure food safety. The second principal component reflected an axis separating food defense and food hygiene. Some items not directly related to food were correlated with this axis. Conclusions: In Japan, the concept of food hygiene is well-established and is generally taken for granted. In contrast, the concept of food defense is relatively new and has not yet fully penetrated the Japanese market. Our research shows that people who think that clothing brands provided added value to clothing products may have similar feelings about food defense. In addition, food hygiene efforts to prevent outbreaks of food poisoning are common in Japan and have been established as the basis of food safety. While food defense efforts are spreading, mainly in companies, it is presumed that they are valuable for the general public as supplementary measures to routine (or basic) food hygiene. %M 37870896 %R 10.2196/43936 %U https://www.i-jmr.org/2023/1/e43936 %U https://doi.org/10.2196/43936 %U http://www.ncbi.nlm.nih.gov/pubmed/37870896 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e50199 %T Exploring Political Mistrust in Pandemic Risk Communication: Mixed-Method Study Using Social Media Data Analysis %A Unlu,Ali %A Truong,Sophie %A Tammi,Tuukka %A Lohiniva,Anna-Leena %+ Finnish Institute for Health and Welfare, Mannerheimintie 166, Helsinki, 00271, Finland, 358 295246000, ali.unlu@thl.fi %K political trust %K social media %K text classification %K topic modeling %K COVID-19 %K Finland %K trust %K authority %K public health outcome %K pandemic %K perception %K mistrust %K interaction %K Twitter %K Facebook %K analysis %K computational method %K natural language processing %K misinformation %K communication %K crisis %D 2023 %7 20.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: This research extends prior studies by the Finnish Institute for Health and Welfare on pandemic-related risk perception, concentrating on the role of trust in health authorities and its impact on public health outcomes. Objective: The paper aims to investigate variations in trust levels over time and across social media platforms, as well as to further explore 12 subcategories of political mistrust. It seeks to understand the dynamics of political trust, including mistrust accumulation, fluctuations over time, and changes in topic relevance. Additionally, the study aims to compare qualitative research findings with those obtained through computational methods. Methods: Data were gathered from a large-scale data set consisting of 13,629 Twitter and Facebook posts from 2020 to 2023 related to COVID-19. For analysis, a fine-tuned FinBERT model with an 80% accuracy rate was used for predicting political mistrust. The BERTopic model was also used for superior topic modeling performance. Results: Our preliminary analysis identifies 43 mistrust-related topics categorized into 9 major themes. The most salient topics include COVID-19 mortality, coping strategies, polymerase chain reaction testing, and vaccine efficacy. Discourse related to mistrust in authority is associated with perceptions of disease severity, willingness to adopt health measures, and information-seeking behavior. Our findings highlight that the distinct user engagement mechanisms and platform features of Facebook and Twitter contributed to varying patterns of mistrust and susceptibility to misinformation during the pandemic. Conclusions: The study highlights the effectiveness of computational methods like natural language processing in managing large-scale engagement and misinformation. It underscores the critical role of trust in health authorities for effective risk communication and public compliance. The findings also emphasize the necessity for transparent communication from authorities, concluding that a holistic approach to public health communication is integral for managing health crises effectively. %M 37862088 %R 10.2196/50199 %U https://www.jmir.org/2023/1/e50199 %U https://doi.org/10.2196/50199 %U http://www.ncbi.nlm.nih.gov/pubmed/37862088 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48508 %T Examining the Persuasive Effects of Health Communication in Short Videos: Systematic Review %A Zhu,Zicheng %A Liu,Shiyu %A Zhang,Renwen %+ Department of Communications and New Media, Faculty of Arts & Social Sciences, National University of Singapore, Blk AS6, #03-41, 11 Computing Drive, Singapore, Singapore, 65 83762508, r.zhang@nus.edu.sg %K short video %K persuasion %K health %K systematic review %K mobile phone %D 2023 %7 13.10.2023 %9 Review %J J Med Internet Res %G English %X Background: The ubiquity of short videos has demonstrated vast potential for health communication. An expansion of research has examined the persuasive effect of health communication in short videos, yet a synthesis of the research is lacking. Objective: This paper aims to provide an overview of the literature by examining the persuasive effect of health communication in short videos, offering guidance for researchers and practitioners. In particular, it seeks to address 4 key research questions: What are the characteristics of short videos, samples, and research designs in short video–based health communication literature? What theories underpin the short video–based health communication literature? What are the persuasive effects of health communication in short videos? and What directions should future research in this area take? Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, an electronic search of 10 databases up to March 10, 2023, generated 4118 results. After the full-text screening, 18 articles met the eligibility criteria. Results: The current research lacks a uniform definition of short videos, demonstrates sample biases in location and education, and adopts limited methodologies. Most studies in this synthesis are theoretically grounded or use theoretical concepts, which are predominantly well examined in persuasion research. Moreover, relevant topics and suitable themes are effective in persuasive health communication outcomes, whereas the impact of diverse narrative techniques remains ambiguous. Conclusions: We recommend that future research extends the definition of short videos beyond time constraints and explores non-Western and less-educated populations. In addition, researchers should consider diverse methods to provide a more comprehensive examination and investigate the impact of audience targeting and narrative techniques in short video health communication. Finally, investigating how the unique aspects of short videos interact with or challenge traditional persuasion theories is essential. %M 37831488 %R 10.2196/48508 %U https://www.jmir.org/2023/1/e48508 %U https://doi.org/10.2196/48508 %U http://www.ncbi.nlm.nih.gov/pubmed/37831488 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47266 %T Effect of Short, Animated Video Storytelling on Maternal Knowledge and Satisfaction in the Perinatal Period in South Africa: Randomized Controlled Trial %A Adam,Maya %A Kwinda,Zwannda %A Dronavalli,Mithilesh %A Leonard,Elizabeth %A Nguyễn,Vān Kính %A Tshivhase,Vusani %A Bärnighausen,Till %A Pillay,Yogan %+ Department of Pediatrics, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, United States, 1 6508393600, madam@stanford.edu %K maternal child health %K mHealth %K mobile health %K randomized controlled trial %K short animated storytelling %K South Africa %K video health messaging %D 2023 %7 13.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Innovative mobile health (mHealth) interventions can improve maternal knowledge, thereby supporting national efforts to reduce preventable maternal and child mortality in South Africa. Studies have documented a potential role for mobile video content to support perinatal health messaging, enhance maternal satisfaction, and overcome literacy barriers. Short, animated storytelling (SAS) is an innovative, emerging approach to mHealth messaging. Objective: We aimed to measure the effect of SAS videos on maternal knowledge and user satisfaction for mothers enrolled in antenatal care programs at 2 public health facilities in the Tshwane District of South Africa. Methods: We used a randomized controlled trial with a nested evaluation of user satisfaction. Participants were randomized 1:1 into Standard-of-Care (SOC) Control, and SAS Intervention groups. The intervention videos were delivered through WhatsApp, and 1 month later, participants responded to telephone surveys assessing their knowledge. The intervention group then participated in a nested evaluation of user satisfaction. Results: We surveyed 204 participants. Of them, 49.5% (101/204) were aged between 25 and 34 years. Almost all participants self-identified as Black, with the majority (190/204, 93.2%) having completed secondary school. The mean overall knowledge score was 21.92/28. We observed a slight increase of 0.28 (95% uncertainty interval [UI] –0.58 to 1.16) in the overall knowledge score in the intervention arm. We found that those with secondary education or above scored higher than those with only primary education by 2.24 (95% UI 0.76-4.01). Participants aged 35 years or older also scored higher than the youngest age group (18-24 years) by 1.83 (95% CI 0.39-3.33). Finally, the nested user satisfaction evaluation revealed high maternal satisfaction (4.71/5) with the SAS video series. Conclusions: While the SAS videos resulted in high user satisfaction, measured knowledge gains were small within a participant population that was already receiving perinatal health messages through antenatal clinics. The higher knowledge scores observed in older participants with higher education levels suggest that boosting maternal knowledge in younger mothers with lower education levels should continue to be a public health priority in South Africa. Given the high maternal satisfaction among the SAS video-users in this study, policy makers should consider integrating similar approaches into existing, broad-reaching perinatal health programs, such as MomConnect, to boost satisfaction and potentially enhance maternal engagement. While previous studies have shown the promise of animated video health education, most of this research has been conducted in high-income countries. More research in underresourced settings is urgently needed, especially as access to mobile technology increases in the Global South. Future studies should explore the effect of SAS videos on maternal knowledge in hard-to-reach populations with limited access to antenatal care, although real-world logistical challenges persist when implementing studies in underresourced South African populations. Trial Registration: Pan African Clinical Trials Registry PACTR202203673222680; https://tinyurl.com/362cpuny %M 37831505 %R 10.2196/47266 %U https://www.jmir.org/2023/1/e47266 %U https://doi.org/10.2196/47266 %U http://www.ncbi.nlm.nih.gov/pubmed/37831505 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43060 %T Approaches to Research Ethics in Health Research on YouTube: Systematic Review %A Tanner,Joshua P %A Takats,Courtney %A Lathan,Hannah Stuart %A Kwan,Amy %A Wormer,Rachel %A Romero,Diana %A Jones,Heidi E %+ CUNY Graduate School of Public Health and Health Policy, 55 W. 125th St, #7th Fl, New York, NY, 10027, United States, 1 646 364 9529, Heidi.Jones@sph.cuny.edu %K data anonymization %K research ethics %K ethics %K informed consent %K public health %K research %K social media %K YouTube %D 2023 %7 4.10.2023 %9 Short Paper %J J Med Internet Res %G English %X Background: YouTube has become a popular source of health care information, reaching an estimated 81% of adults in 2021; approximately 35% of adults in the United States have used the internet to self-diagnose a condition. Public health researchers are therefore incorporating YouTube data into their research, but guidelines for best practices around research ethics using social media data, such as YouTube, are unclear. Objective: This study aims to describe approaches to research ethics for public health research implemented using YouTube data. Methods: We implemented a systematic review of articles found in PubMed, SocINDEX, Web of Science, and PsycINFO following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. To be eligible to be included, studies needed to be published in peer-reviewed journals in English between January 1, 2006, and October 31, 2019, and include analyses on publicly available YouTube data on health or public health topics; studies using primary data collection, such as using YouTube for study recruitment, interventions, or dissemination evaluations, were not included. We extracted data on the presence of user identifying information, institutional review board (IRB) review, and informed consent processes, as well as research topic and methodology. Results: This review includes 119 articles from 88 journals. The most common health and public health topics studied were in the categories of chronic diseases (44/119, 37%), mental health and substance use (26/119, 21.8%), and infectious diseases (20/119, 16.8%). The majority (82/119, 68.9%) of articles made no mention of ethical considerations or stated that the study did not meet the definition of human participant research (16/119, 13.4%). Of those that sought IRB review (15/119, 12.6%), 12 out of 15 (80%) were determined to not meet the definition of human participant research and were therefore exempt from IRB review, and 3 out of 15 (20%) received IRB approval. None of the 3 IRB-approved studies contained identifying information; one was explicitly told not to include identifying information by their ethics committee. Only 1 study sought informed consent from YouTube users. Of 119 articles, 33 (27.7%) contained identifying information about content creators or video commenters, one of which attempted to anonymize direct quotes by not including user information. Conclusions: Given the variation in practice, concrete guidelines on research ethics for social media research are needed, especially around anonymizing and seeking consent when using identifying information. Trial Registration: PROSPERO CRD42020148170; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=148170 %M 37792443 %R 10.2196/43060 %U https://www.jmir.org/2023/1/e43060 %U https://doi.org/10.2196/43060 %U http://www.ncbi.nlm.nih.gov/pubmed/37792443 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45343 %T Mediating and Moderating Effects of Internet Use on Urban-Rural Disparities in Health Among Older Adults: Nationally Representative Cross-Sectional Survey in China %A Liu,Jing %A Peng,Junwei %A Chen,Minyan %A Zhang,Tao %+ Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, No. 2318, Yuhangtang Rd, Yuhang District, Hangzhou, 311100, China, 86 18768429445, lucky1230405@163.com %K internet use %K cognitive function %K depressive symptoms %K functional disability %K mediation analysis %K mobile phone %D 2023 %7 28.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The urban-rural disparities in health outcomes in China are remarkable. The internet has shown the potential to reduce the likelihood of contracting a disease by increasing disease knowledge. However, little is known about the effects of internet use in alleviating health inequities between urban and rural areas. Objective: This study aimed to examine the mediation and moderation of health disparities between urban and rural older adults through internet use. Methods: A total of 8223 respondents were selected from the China Health and Retirement Longitudinal Study 2018 data set. Basic activities of daily living, a brief Community Screening Instrument for Dementia, and the Centre for Epidemiologic Studies Depression Scale were used to measure functional disability, cognitive function, and depressive symptoms, respectively. Logistic regressions testing “internet use×urban-rural status” interactions for moderation and Karlson-Holm-Breen decomposition for mediation were performed. Results: Internet use moderated the urban-rural disparities in cognitive function (odds ratio 7.327, 95% CI 3.011-17.832) and depressive symptoms (odds ratio 1.070, 95% CI 1.037-1.787), but the moderating effects were significant only for those using the internet daily. Karlson-Holm-Breen results showed the suppression effects of using the internet daily (β=.012, 95% CI .002-.021) on the association between urban-rural status and cognitive function. The urban-rural inequality in depressive symptoms was partially attributed to the disparity in internet use (β=−.027, 95% CI −.043 to −.009). Conclusions: The urban-rural inequalities in mental health are partially attributable to disparities in the prevalence of internet use between the 2 groups. However, using the internet is more beneficial for the psychological health of rural users, thereby alleviating the urban-rural disparities in health. Providing convenient channels for rural older adults to use the internet, improving the ability of rural users to effectively use the internet, and promoting internet popularity in rural areas are effective approaches to reducing urban-rural health inequalities. %M 37768721 %R 10.2196/45343 %U https://www.jmir.org/2023/1/e45343 %U https://doi.org/10.2196/45343 %U http://www.ncbi.nlm.nih.gov/pubmed/37768721 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47548 %T Health Care Provider Stigma Toward Patients With Substance Use Disorders: Protocol for a Nationally Representative Survey %A Parish,Carrigan Leigh %A Feaster,Daniel J %A Pollack,Harold A %A Horigian,Viviana E %A Wang,Xiaoming %A Jacobs,Petra %A Pereyra,Margaret R %A Drymon,Christina %A Allen,Elizabeth %A Gooden,Lauren K %A del Rio,Carlos %A Metsch,Lisa R %+ Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, Miami Research Center, 1120 NW 14th St, Miami, FL, 33136, United States, 1 9546469499, cp2695@columbia.edu %K substance use disorders %K provider stigma %K cross-sectional survey study %K provider attitudes %K survey methodology %D 2023 %7 26.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The US overdose epidemic is an escalating public health emergency, accounting for over 100,000 deaths annually. Despite the availability of medications for opioid use disorders, provider-level barriers, such as negative attitudes, exacerbate the treatment gap in clinical care settings. Assessing the prevalence and intensity of provider stigma, defined as the negative perceptions and behaviors that providers embody and enact toward patients with substance use disorders, across providers with different specialties, is critical to expanding the delivery of substance use treatment. Objective: To thoroughly understand provider stigma toward patients with substance use disorders, we conducted a nationwide survey of emergency medicine and primary care physicians and dentists using a questionnaire designed to reveal how widely and intensely provider attitudes and stigma can impact these providers’ clinical practices in caring for their patients. The survey also queried providers’ stigma and clinical practices toward other chronic conditions, which can then be compared with their stigma and practices related to substance use disorders. Methods: Our cross-sectional survey was mailed to a nationally representative sample of primary care physicians, emergency medicine physicians, and dentists (N=3011), obtained by American Medical Association and American Dental Association licensees based on specified selection criteria. We oversampled nonmetropolitan practice areas, given the potential differences in provider stigma and available resources in these regions compared with metropolitan areas. Data collection followed a recommended series of contacts with participants per the Dillman Total Design Method, with mixed-modality options offered (email, mail, fax, and phone). A gradually increasing compensation scale (maximum US$250) was implemented to recruit chronic nonresponders and assess the association between requiring higher incentives to participate and providers stigma. The primary outcome, provider stigma, was measured using the Medical Condition Regard Scale, which inquired about participants’ views on substance use and other chronic conditions. Additional survey measures included familiarity and social engagement with people with substance use disorders; clinical practices (screening, treating, and referring for a range of chronic conditions); subjective norms and social desirability; knowledge and prior education; and descriptions of their patient populations. Results: Data collection was facilitated through collaboration with the National Opinion Research Center between October 2020 and October 2022. The overall Council of American Survey Research Organizations completion rate was 53.62% (1240/2312.7; physicians overall: 855/1681.9, 50.83% [primary care physicians: 506/1081.3, 46.79%; emergency medicine physicians: 349/599.8, 58.2%]; dentists: 385/627.1, 61.4%). The ineligibility rate among those screened is applied to those not screened, causing denominators to include fractional numbers. Conclusions: Using systematically quantified data on the prevalence and intensity of provider stigma toward substance use disorders in health care, we can provide evidence-based improvement strategies and policies to inform the development and implementation of stigma-reduction interventions for providers to address their perceptions and treatment of substance use. International Registered Report Identifier (IRRID): DERR1-10.2196/47548 %M 37751236 %R 10.2196/47548 %U https://www.researchprotocols.org/2023/1/e47548 %U https://doi.org/10.2196/47548 %U http://www.ncbi.nlm.nih.gov/pubmed/37751236 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49593 %T Integrated Real-World Study Databases in 3 Diverse Asian Health Care Systems in Taiwan, India, and Thailand: Scoping Review %A Shau,Wen-Yi %A Setia,Sajita %A Chen,Ying-Jan %A Ho,Tsu-yun %A Prakash Shinde,Salil %A Santoso,Handoko %A Furtner,Daniel %+ Executive Office, Transform Medical Communications Limited, 184 Glasgow Street, Wanganui, 4500, New Zealand, 64 0276175433, sajita.setia@transform-medcomms.com %K Asia %K health care databases %K real-world data %K real-world evidence %K scoping review %D 2023 %7 11.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of real-world data (RWD) warehouses for research in Asia is on the rise, but current trends remain largely unexplored. Given the varied economic and health care landscapes in different Asian countries, understanding these trends can offer valuable insights. Objective: We sought to discern the contemporary landscape of linked RWD warehouses and explore their trends and patterns in 3 Asian countries with contrasting economies and health care systems: Taiwan, India, and Thailand. Methods: Using a systematic scoping review methodology, we conducted an exhaustive literature search on PubMed with filters for the English language and the past 5 years. The search combined Medical Subject Heading terms and specific keywords. Studies were screened against strict eligibility criteria to identify eligible studies using RWD databases from more than one health care facility in at least 1 of the 3 target countries. Results: Our search yielded 2277 studies, of which 833 (36.6%) met our criteria. Overall, single-country studies (SCS) dominated at 89.4% (n=745), with cross-country collaboration studies (CCCS) being at 10.6% (n=88). However, the country-wise breakdown showed that of all the SCS, 623 (83.6%) were from Taiwan, 81 (10.9%) from India, and 41 (5.5%) from Thailand. Among the total studies conducted in each country, India at 39.1% (n=133) and Thailand at 43.1% (n=72) had a significantly higher percentage of CCCS compared to Taiwan at 7.6% (n=51). Over a 5-year span from 2017 to 2022, India and Thailand experienced an annual increase in RWD studies by approximately 18.2% and 13.8%, respectively, while Taiwan’s contributions remained consistent. Comparative effectiveness research (CER) was predominant in Taiwan (n=410, or 65.8% of SCS) but less common in India (n=12, or 14.8% of SCS) and Thailand (n=11, or 26.8% of SCS). CER percentages in CCCS were similar across the 3 countries, ranging from 19.2% (n=10) to 29% (n=9). The type of RWD source also varied significantly across countries, with India demonstrating a high reliance on electronic medical records or electronic health records at 55.6% (n=45) of SCS and Taiwan showing an increasing trend in their use over the period. Registries were used in 26 (83.9%) CCCS and 31 (75.6%) SCS from Thailand but in <50% of SCS from Taiwan and India. Health insurance/administrative claims data were used in most of the SCS from Taiwan (n=458, 73.5%). There was a consistent predominant focus on cardiology/metabolic disorders in all studies, with a noticeable increase in oncology and infectious disease research from 2017 to 2022. Conclusions: This review provides a comprehensive understanding of the evolving landscape of RWD research in Taiwan, India, and Thailand. The observed differences and trends emphasize the unique economic, clinical, and research settings in each country, advocating for tailored strategies for leveraging RWD for future health care research and decision-making. International Registered Report Identifier (IRRID): RR2-10.2196/43741 %M 37615085 %R 10.2196/49593 %U https://www.jmir.org/2023/1/e49593 %U https://doi.org/10.2196/49593 %U http://www.ncbi.nlm.nih.gov/pubmed/37615085 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e43492 %T Mobile Health–Supported Active Syndrome Surveillance for COVID-19 Early Case Finding in Addis Ababa, Ethiopia: Comparative Study %A Bisrat,Haileleul %A Manyazewal,Tsegahun %A Fekadu,Abebaw %+ Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, BL_03_420 St., Addis Abeba, 9086, Ethiopia, 251 911940459, haylishb2@gmail.com %K mobile health %K mHealth %K digital health %K COVID-19 %K syndrome assessment %K surveillance %K Ethiopia %K public health %K syndrome surveillance %K self-care %K telemedicine %K telecom, SARS-CoV-2 %D 2023 %7 28.8.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: Since most people in low-income countries do not have access to reliable laboratory services, early diagnosis of life-threatening diseases like COVID-19 remains challenging. Facilitating real-time assessment of the health status in a given population, mobile health (mHealth)–supported syndrome surveillance might help identify disease conditions earlier and save lives cost-effectively. Objective: This study aimed to evaluate the potential use of mHealth-supported active syndrome surveillance for COVID-19 early case finding in Addis Ababa, Ethiopia. Methods: A comparative cross-sectional study was conducted among adults randomly selected from the Ethio telecom list of mobile phone numbers. Participants underwent a comprehensive phone interview for COVID-19 syndromic assessments, and their symptoms were scored and interpreted based on national guidelines. Participants who exhibited COVID-19 syndromes were advised to have COVID-19 diagnostic testing at nearby health care facilities and seek treatment accordingly. Participants were asked about their test results, and these were cross-checked against the actual facility-based data. Estimates of COVID-19 detection by mHealth-supported syndromic assessments and facility-based tests were compared using Cohen Kappa (κ), the receiver operating characteristic curve, sensitivity, and specificity analysis. Results: A total of 2741 adults (n=1476, 53.8% men and n=1265, 46.2% women) were interviewed through the mHealth platform during the period from December 2021 to February 2022. Among them, 1371 (50%) had COVID-19 symptoms at least once and underwent facility-based COVID-19 diagnostic testing as self-reported, with 884 (64.5%) confirmed cases recorded in facility-based registries. The syndrome assessment model had an optimal likelihood cut-off point sensitivity of 46% (95% CI 38.4-54.6) and specificity of 98% (95% CI 96.7-98.9). The area under the receiver operating characteristic curve was 0.87 (95% CI 0.83-0.91). The level of agreement between the mHealth-supported syndrome assessment and the COVID-19 test results was moderate (κ=0.54, 95% CI 0.46-0.60). Conclusions: In this study, the level of agreement between the mHealth-supported syndromic assessment and the actual laboratory-confirmed results for COVID-19 was found to be reasonable, at 89%. The mHealth-supported syndromic assessment of COVID-19 represents a potential alternative method to the standard laboratory-based confirmatory diagnosis, enabling the early detection of COVID-19 cases in hard-to-reach communities, and informing patients about self-care and disease management in a cost-effective manner. These findings can guide future research efforts in developing and integrating digital health into continuous active surveillance of emerging infectious diseases. %M 37556182 %R 10.2196/43492 %U https://www.i-jmr.org/2023/1/e43492 %U https://doi.org/10.2196/43492 %U http://www.ncbi.nlm.nih.gov/pubmed/37556182 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45963 %T Selective Prevention of Depression in Workers Using a Smartphone App: Randomized Controlled Trial %A Deady,Mark %A Collins,Daniel A J %A Lavender,Isobel %A Mackinnon,Andrew %A Glozier,Nicholas %A Bryant,Richard %A Christensen,Helen %A Harvey,Samuel B %+ Black Dog Institute, Faculty of Medicine and Health, University of New South Wales, Hospital Rd, Randwick, 2031, Australia, 61 02 9065 9144, m.deady@unsw.edu.au %K depression %K smartphone app %K workplace mental health %K randomized controlled trial %K prevention %K stress %K mobile phone %D 2023 %7 24.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: There is increasing evidence that depression can be prevented; however, universal approaches have had limited success. Appropriate targeting of interventions to at-risk populations has been shown to have potential, but how to selectively determine at-risk individuals remains unclear. Workplace stress is a risk factor for depression and a target for intervention, but few interventions exist to prevent depression among workers at risk due to heightened stress. Objective: This trial aimed to evaluate the efficacy of a smartphone-based intervention in reducing the onset of depression and improving related outcomes in workers experiencing at least moderate levels of stress. Methods: A randomized controlled trial was conducted with participants who were currently employed and reported no clinically significant depression and at least moderate stress. The intervention group (n=1053) were assigned Anchored, a 30-day self-directed smartphone app-based cognitive behavioral- and mindfulness-based intervention. The attention-control group (n=1031) were assigned a psychoeducation website. Assessment was performed via web-based self-report questionnaires at baseline and at 1-, 3-, and 6-month postbaseline time points. The primary outcome was new depression caseness aggregated over the follow-up period. The secondary outcomes included depressive and anxiety symptoms, stress, well-being, resilience, work performance, work-related burnout, and quality of life. Analyses were conducted within an intention-to-treat framework using mixed modeling. Results: There was no significant between-group difference in new depression caseness (z score=0.69; P=.49); however, those in the Anchored arm had significantly greater depressive symptom reduction at 1 month (Cohen d=0.02; P=.049) and 6 months (Cohen d=0.08; P=.03). Anchored participants also showed significantly greater reduction in anxiety symptoms at 1 month (Cohen d=0.07; P=.04) and increased work performance at 1 month (Cohen d=0.07; P=.008) and 6 months (Cohen d=0.13; P=.01), compared with controls. Notably, for Anchored participants completing at least two-thirds of the intervention, there was a significantly lower rate of depression onset (1.1%, 95% CI 0.0%-3.7%) compared with controls (9.0%, 95% CI 6.8%-12.3%) at 1 month (z score=4.50; P<.001). Significant small to medium effect sizes for most secondary outcomes were seen in the highly engaged Anchored users compared with controls, with effects maintained at the 6-month follow-up for depressive symptoms, well-being, stress, and quality of life. Conclusions: Anchored was associated with a small comparative reduction in depressive symptoms compared with controls, although selective prevention of case-level depression was not observed in the intention-to-treat analysis. When users adequately engaged with the app, significant findings pertaining to depression prevention, overall symptom reduction, and functional improvement were found, compared with controls. There is a need for a greater focus on engagement techniques in future research. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000178943; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378592 %M 37616040 %R 10.2196/45963 %U https://www.jmir.org/2023/1/e45963 %U https://doi.org/10.2196/45963 %U http://www.ncbi.nlm.nih.gov/pubmed/37616040 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42528 %T Assessing the Effect of Nonvisual Information Factors in Pandemic-Related Video Communication: Randomized Controlled Between-Subjects Experiment %A Lungu,Daniel Adrian %A Røislien,Jo %A Berg,Siv Hilde %A Smeets,Ionica %A Shortt,Marie Therese %A Thune,Henriette %A Brønnick,Kolbjørn Kallesten %+ SHARE – Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, PO Box 8600, Stavanger, 4036, Norway, 47 91532327, daniel.a.lungu@uis.no %K video communication %K COVID-19 %K trust %K comprehension %K intentions %K behavior %K visual %K pandemic %K risk %K communication %K policy %K behavior %K effect %K video %K experiment %D 2023 %7 23.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Videos have been an important medium for providing health and risk communication to the public during the COVID-19 pandemic. Public health officials, health care professionals, and policy makers have used videos to communicate pandemic-related content to large parts of the population. Evidence regarding the outcomes of such communication, along with their determinants, is however limited. Objective: The aim of this study was to test the impact of nonvisual information factors of video communication on 4 outcomes: trust, comprehension, intentions, and behavior. Methods: Twelve short health communication videos related to pandemics were produced and shown to a large sample of participants, applying a randomized controlled between-subjects design. Three factors were included in the creation of the videos: the topic (exponential growth, handwashing, and burden of pandemics on the health care system), the source (expert and nonexpert), and a call to action (present or absent). Participants were randomly assigned to 1 video intervention, and 1194 valid replies were collected. The data were analyzed using factorial ANOVA. Results: The 3 pandemic-related topics did not affect trust, comprehension, intentions, or behavior. Trust was positively influenced by an expert source (2.5%), whereas a nonexpert source instead had a positive effect on the proxy for behavior (5.7%) compared with the expert source. The inclusion of a call to action had a positive effect on both trust (4.1%) and comprehension (15%). Conclusions: Trust and comprehension in pandemic-related video communication can be enhanced by using expert sources and by including a call to action, irrespective of the topic being communicated. Intentions and behavior appear to be affected to a small extent by the 3 factors tested in this study. International Registered Report Identifier (IRRID): RR2-10.2196/34275 %M 37610820 %R 10.2196/42528 %U https://www.jmir.org/2023/1/e42528 %U https://doi.org/10.2196/42528 %U http://www.ncbi.nlm.nih.gov/pubmed/37610820 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e42469 %T Association of Catastrophic Health Expenditure With the Risk of Depression in Chinese Adults: Population-Based Cohort Study %A Wang,Yaping %A Liang,Wannian %A Liu,Min %A Liu,Jue %+ Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, China, 86 10 8 2805146, liumin@bjmu.edu.cn %K catastrophic health expenditure %K depression %K universal health coverage %K economic burden %K socioeconomic status %D 2023 %7 15.8.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Depression is one of the most common mental illnesses, and it may have a lasting effect on one’s whole life. As a form of financial hardship, catastrophic health expenditure (CHE) may be associated with depression. However, current evidence about the relationship between CHE and the risk of depression is insufficient. Objective: This study aimed to explore the relationship between CHE and the risk of depression among Chinese adults. Methods: In this study, we used 3 waves of the China Family Panel Studies (CFPS) from 2012, 2016, and 2018. The CFPS are a nationally representative study covering 25 of 31 provinces in Chinese mainland and representing nearly 94.5% of the total population. We selected eligible household heads as participants, divided them into 2 groups by CHE events at baseline (exposed group: with CHE; unexposed group: without CHE), and followed them up. Households with CHE were defined as having out-of-pocket medical expenditures exceeding 40% of the total household nonfood expenditure, and people with depression were identified by the 8-item Centre for Epidemiological Studies Depression Scale (CES-D). We first described the baseline characteristics and used logistical regression to estimate their effects on CHE events. Then, we used Cox proportional hazard models to estimate adjusted hazard ratios and 95% CIs of depression among participants with CHE compared with those without CHE. Finally, we analyzed the subgroup difference in the association between CHE and depression. Results: Of a total of 13,315 households, 9629 were eligible for analysis. Among them, 6824 (70.9%) were men. The mean age was 50.15 (SD 12.84) years. Only 987 (10.3%) participants had no medical insurance. The prevalence of CHE at baseline was 12.9% (1393/9629). Participants with a higher family economic level (adjusted odds ratio [aOR] 1.15, 95% CI 1.02-1.31) and with the highest socioeconomic development level (aOR 1.18, 95% CI 1.04-1.34) had a higher prevalence of CHE than reference groups. During a median of 71 (IQR 69-72) person-months of follow-up, the depression incidence of participants with CHE (1.41 per 1000 person-months) was higher than those without CHE (0.73 per 1000 person-months). Multivariable models revealed that the adjusted hazard ratio for the incidence of depression in participants with CHE was 1.33 (95% CI 1.08-1.64), and this association appeared to be greater in participants without outpatient services (for interaction, P=.048). Conclusions: CHE was significantly associated with increased risk of depression among Chinese adults. Concentrated work should be done to monitor CHE, and more efforts to ensure financial protection need to be made to prevent depression, especially for people with high health care needs. %M 37581926 %R 10.2196/42469 %U https://publichealth.jmir.org/2023/1/e42469 %U https://doi.org/10.2196/42469 %U http://www.ncbi.nlm.nih.gov/pubmed/37581926 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e39154 %T Supporting Public Health Research Capacity, Quality, and Productivity in a Diverse Region %A AlHamawi,Rana %A Saad,Randa K %A Abdul Rahim,Hanan F %A Mir Islam Saeed,Khwaja %A Husseini,Abdullatif %A Khader,Yousef %A Al Nsour,Mohannad %+ Global Health Development/Eastern Mediterranean Public Health Network, Abdallah Ben Abbas St, Building No. 42, Amman, 11196, Jordan, 962 6 5519962, randaksaad@gmail.com %K health research %K Public health %K Eastern Mediterranean region %K Research capacity %K Research Quality %D 2023 %7 31.7.2023 %9 Viewpoint %J Interact J Med Res %G English %X Public health research plays a critical role in strengthening health systems and improving their performance and impact. However, scholarly production in public health coming from the Eastern Mediterranean Region (EMR) remains well below the world average and lacks a tangible growth trend over time. During the seventh Eastern Mediterranean Public Health Network Regional Conference, a roundtable session brought together a panel of public health experts representing Global Health Development/Eastern Mediterranean Public Health Network affiliates, universities or academia, and research institutions from the region, where they shared insights on the current situation of public health research; challenges and barriers to research facing the different countries in the EMR and the region in general; and how research agendas, productivity, and quality can be supported through strengthening research capacity in the region. Although the region is diverse in terms of health system capacity and socioeconomic development, several common challenges were identified, including a lack of strategic prioritization to guide health research, insufficient funding, ineffective transfer of knowledge to policy and practice, limited availability of research facilities, and limited national and international research collaboration. Occupied countries and countries in a state of conflict, such as Palestine, face additional barriers, such as personal and social security, lack of control of borders and natural resources, travel and movement restrictions, and confidentiality challenges because of the continuing war conditions and occupation. However, there have been success stories in the EMR regarding research publications and their positive and effective impact on policy and decision-makers. To improve research resilience and public health care in the region, a collaborative approach involving institutions, policymakers, and relevant stakeholders is critical. %M 37523227 %R 10.2196/39154 %U https://www.i-jmr.org/2023/1/e39154 %U https://doi.org/10.2196/39154 %U http://www.ncbi.nlm.nih.gov/pubmed/37523227 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e47156 %T Association of Socioeconomic Status With Long-Term Outcome in Survivors After Out-of-Hospital Cardiac Arrest: Nationwide Population-Based Longitudinal Study %A Yoo,Kyung Hun %A Cho,Yongil %A Oh,Jaehoon %A Lee,Juncheol %A Ko,Byuk Sung %A Kang,Hyunggoo %A Lim,Tae Ho %A Lee,Sang Hwan %+ Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, 04763, Republic of Korea, 82 2 2290 9829, ojjai@hanmail.net %K out-of-hospital cardiac arrest %K OHCA %K socioeconomic status %K SES %K long-term outcome %K survivor %K public health %K cardiac arrest %K socioeconomic disparities %K hospital discharge %K clinical outcomes %D 2023 %7 11.7.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Out-of-hospital cardiac arrest (OHCA) is a major public health problem and a leading cause of death worldwide. Previous studies have focused on improving the survival of people who have had OHCA by analyzing short-term survival outcomes, such as the return of spontaneous circulation, 30-day survival, and survival to discharge. Research has been conducted on prehospital prognostic factors to improve the survival of patients with OHCA, among which the association between socioeconomic status (SES) and survival has been reported. SES could affect bystander cardiopulmonary resuscitation rates and whether OHCA is witnessed, and low cardiopulmonary resuscitation education rates are associated with low SES. It has been reported that areas with high SES have shorter hospital transfer times and more public defibrillators per person. Previous studies have shown the impact of SES disparities on the short-term survival of patients with OHCA. However, understanding the impact of SES on the long-term prognosis of OHCA survivors remains limited. As long-term outcomes are more indicative of a patient’s ongoing health care needs and the burden on public health than short-term outcomes, understanding the long-term prognosis of OHCA survivors is important. Objective: This study aimed to identify whether SES influenced the long-term outcomes of OHCA. Methods: Using health claims data obtained from the National Health Insurance (NHI) service in Korea, we included OHCA survivors who were hospitalized between January 2005 and December 2015. The patients were divided into 2 groups: NHI and Medical Aid (MA) groups, with the MA group defined as having a low SES. Cumulative mortality was estimated using the Kaplan-Meier method, and a Cox proportional hazards model was used to evaluate the impact of SES on long-term mortality. A subgroup analysis was performed based on whether cardiac procedures were performed. Results: We followed 4873 OHCA survivors for up to 14 years (median of 3.3 years). The Kaplan-Meier survival curve showed that the MA group had a significantly decreased long-term survival rate compared to the NHI group. With an adjusted hazard ratio (aHR) of 1.52 (95% CI 1.35-1.72), low SES was associated with increased long-term mortality. The overall mortality rate of the patients who underwent cardiac procedures in the MA group was significantly higher than that of the NHI group (aHR 1.72, 95% CI 1.05-2.82). The overall mortality rate of patients without cardiac procedures was also increased in the MA group compared to the NHI group (aHR 1.39, 95% CI 1.23-1.58). Conclusions: OHCA survivors with low SES had an increased risk of poor long-term outcomes compared with those with higher SES. OHCA survivors with low SES who have undergone cardiac procedures need considerable care for long-term survival. %M 37432716 %R 10.2196/47156 %U https://publichealth.jmir.org/2023/1/e47156 %U https://doi.org/10.2196/47156 %U http://www.ncbi.nlm.nih.gov/pubmed/37432716 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e41435 %T Effect of Rapid Urbanization in Mainland China on the Seasonal Influenza Epidemic: Spatiotemporal Analysis of Surveillance Data From 2010 to 2017 %A Lei,Hao %A Zhang,Nan %A Niu,Beidi %A Wang,Xiao %A Xiao,Shenglan %A Du,Xiangjun %A Chen,Tao %A Yang,Lei %A Wang,Dayan %A Cowling,Benjamin %A Li,Yuguo %A Shu,Yuelong %+ School of Public Health, Zhejiang University, 866 Yu-hang-tang Road, Hangzhou, 310058, China, 86 0571 8707 6051, leolei@zju.edu.cn %K seasonal influenza %K attack rate %K urbanization %K urban population %K human contact %K agent-based model %K influenza %K seasonal flu %K spatiotemporal %K epidemic %K disease transmission %K disease spread %K epidemiology %K influenza transmission %K epidemics %D 2023 %7 7.7.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The world is undergoing an unprecedented wave of urbanization. However, the effect of rapid urbanization during the early or middle stages of urbanization on seasonal influenza transmission remains unknown. Since about 70% of the world population live in low-income countries, exploring the impact of urbanization on influenza transmission in urbanized countries is significant for global infection prediction and prevention. Objective: The aim of this study was to explore the effect of rapid urbanization on influenza transmission in China. Methods: We performed spatiotemporal analyses of province-level influenza surveillance data collected in Mainland China from April 1, 2010, to March 31, 2017. An agent-based model based on hourly human contact–related behaviors was built to simulate the influenza transmission dynamics and to explore the potential mechanism of the impact of urbanization on influenza transmission. Results: We observed persistent differences in the influenza epidemic attack rates among the provinces of Mainland China across the 7-year study period, and the attack rate in the winter waves exhibited a U-shaped relationship with the urbanization rates, with a turning point at 50%-60% urbanization across Mainland China. Rapid Chinese urbanization has led to increases in the urban population density and percentage of the workforce but decreases in household size and the percentage of student population. The net effect of increased influenza transmission in the community and workplaces but decreased transmission in households and schools yielded the observed U-shaped relationship. Conclusions: Our results highlight the complicated effects of urbanization on the seasonal influenza epidemic in China. As the current urbanization rate in China is approximately 59%, further urbanization with no relevant interventions suggests a worrisome increasing future trend in the influenza epidemic attack rate. %M 37418298 %R 10.2196/41435 %U https://publichealth.jmir.org/2023/1/e41435 %U https://doi.org/10.2196/41435 %U http://www.ncbi.nlm.nih.gov/pubmed/37418298 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43776 %T Correlation Between Opioid Drug Prescription and Opioid-Related Mortality in Spain as a Surveillance Tool: Ecological Study %A Salazar,Alejandro %A Moreno-Pulido,Soledad %A Prego-Meleiro,Pablo %A Henares-Montiel,Jesús %A Pulido,José %A Donat,Marta %A Sotres-Fernandez,Gabriel %A Sordo,Luis %+ Department of Mathematics, University of Cádiz, Avenida de la Universidad de Cádiz, s/n, Puerto Real, 11510, Spain, 34 956483474, soledad.moreno@uca.es %K opioid %K overdose %K drug overdose %K opioid-related deaths %K mortality %K tramadol %K fentanyl %K substance use %K substance misuse %K substance abuse %K ecological study %K death %D 2023 %7 28.6.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Opioid drug prescription (ODP) and opioid-related mortality (ORM) have increased in Spain. However, their relationship is complex, as ORM is registered without considering the type of opioid (legal or illegal). Objective: This ecological study aimed to examine the correlation between ODP and ORM in Spain and discuss their usefulness as a surveillance tool. Methods: This was an ecological descriptive study using retrospective annual data (2000-2019) from the Spanish general population. Data were collected from people of all ages. Information on ODP was obtained from the Spanish Medicines Agency in daily doses per 1000 inhabitants per day (DHD) for total ODP, total ODP excluding those with better safety protocols (codeine and tramadol), and each opioid drug separately. Rates of ORM (per 1,000,000 inhabitants) were calculated based on deaths registered (International Classification of Diseases, 10th Revision codes) as opioid poisoning by the National Statistics Institute, derived from the drug data recorded by medical examiners in death certificates. Opioid-related deaths were considered to be those that indicated opioid consumption (accidental, infringed, or self-inflicted) as the main cause of death: death due to accidental poisoning (X40-X44), intentional self-inflicted poisoning (X60-X64), drug-induced aggression (X85), and poisoning of undetermined intention (Y10-Y14). A descriptive analysis was carried out, and correlations between the annual rates of ORM and DHD of the prescribed opioid drugs globally, excluding medications of the least potential risk of overdose and lowest treatment tier, were analyzed using Pearson linear correlation coefficient. Their temporal evolution was analyzed using cross-correlations with 24 lags and the cross-correlation function. The analyses were carried out using Stata and StatGraphics Centurion 19. Results: The rate of ORM (2000-2019) ranged between 14 and 23 deaths per 1,000,000 inhabitants, with a minimum in 2006 and an increasing trend starting in 2010. The ODP ranged between 1.51 to 19.94 DHD. The rates of ORM were directly correlated with the DHD of total ODP (r=0.597; P=.006), total ODP without codeine and tramadol (r=0.934; P<.001), and every prescribed opioid except buprenorphine (P=.47). In the time analysis, correlations between DHD and ORM were observed in the same year, although not statistically significant (all P≥.05). Conclusions: There is a correlation between greater availability of prescribed opioid drugs and an increase in opioid-related deaths. The correlation between ODP and ORM may be a useful tool in monitoring legal opiates and possible disturbances in the illegal market. The role of tramadol (an easily prescribed opioid) is important in this correlation, as is that of fentanyl (the strongest opioid). Measures stronger than recommendations need to be taken to reduce off-label prescribing. This study shows that not only is opioid use directly related to the prescribing of opioid drugs above what is desirable but also an increase in deaths. %M 37379061 %R 10.2196/43776 %U https://publichealth.jmir.org/2023/1/e43776 %U https://doi.org/10.2196/43776 %U http://www.ncbi.nlm.nih.gov/pubmed/37379061 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e39978 %T Evaluation of a Community Suicide Prevention Project (Roots of Hope): Protocol for an Implementation Science Study %A Mishara,Brian L %A Tran,Anh Tu %A Chondo,Lianna %A Demmer,Amanda %A Harris-Lane,Laura %A Harper,Sheila %A Jbilou,Jalila %A Williams-Roberts,Hazel %A Wilson,Tanya %+ Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, C.P. 8888, Succ. Centre-Ville, Montréal, QC, H3C3P8, Canada, 1 5149874832, mishara.brian@uqam.ca %K suicide %K prevention %K community %K evaluation %K implementation science %K implementation research %K impact %K mental health %K psychological health %K public health %K community health %D 2023 %7 14.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Roots of Hope (RoH) is a multisite Canadian community-based suicide prevention initiative developed by the Mental Health Commission of Canada (MHCC), which is based on evidence for intervention effectiveness and World Health Organization recommendations. Seven communities developed local activities in the following 5 pillars: specialized supports, training and networks, public awareness, means safety, and evaluation research. Objective: We aim to use an implementation research approach to understand the RoH model for reducing suicidal behaviors and their impacts in communities, and the lessons learned for the equitable development and implementation of RoH in different contexts. Moreover, we want to understand how the program is implemented in relation to the context, the causal pathways, and the factors influencing successful implementation. The evaluation includes assessments of short-term and intermediate effects at each site and overall. Methods: The principal investigator (PI) developed a consensus among local research coordinators on common approaches and indicators through ongoing participation in an online community of practice, and regular virtual and in-person meetings. At the completion of the pilot phase, the PI will summarize evaluation results across sites and conduct pooled analyses. The RoH theory of change and evaluation model shows how evaluation activities from the planning phase through the implementation of activities in each of the pillars can help clarify the viability of the RoH model and identify factors that facilitate and inhibit effective and equitable implementation in different contexts. Beginning with a situational analysis to identify resources in each community and local specificities, we will examine the implementation characteristics of conformity, dosage, coverage, quality, utility, equity, appreciation, facilitators, and impediments. Evaluation of short-term effects will focus on changes in knowledge, attitudes, behaviors, help-seeking, service use, stigma, media reports, empowerment, and care experiences. Intermediate effects, long-term effects, and impact will include assessments of the changes in suicides, suicide attempt rates, and suicide risk indicators. A variety of data sources, both quantitative and qualitative, will be used. Results: The quantitative and qualitative data from all sites will be summarized by the PI in March 2023 to draw conclusions to help the MHCC in its improvements to the RoH model, and to inform communities about how to better implement RoH. Since the COVID-19 pandemic occurred at the beginning of program implementation, its impact and influence will be documented. The validity of RoH in contributing to the prevention of suicides and suicidal behaviors will be clarified in a variety of contexts. The final evaluation report will be available in September 2023. Conclusions: The evaluation results, including the identification of factors that facilitate and inhibit the implementation of RoH and the adaptations to challenges, will be useful to the MHCC, current RoH communities, and those considering adopting the RoH model. International Registered Report Identifier (IRRID): DERR1-10.2196/39978 %M 36961777 %R 10.2196/39978 %U https://www.researchprotocols.org/2023/1/e39978 %U https://doi.org/10.2196/39978 %U http://www.ncbi.nlm.nih.gov/pubmed/36961777 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47900 %T Leptospirosis in Aotearoa New Zealand: Protocol for a Nationwide Case-Control Study %A Nisa,Shahista %A Vallee,Emilie %A Marshall,Jonathan %A Collins-Emerson,Julie %A Yeung,Polly %A Prinsen,Gerard %A Douwes,Jeroen %A Baker,Michael G %A Wright,Jackie %A Quin,Tanya %A Holdaway,Maureen %A Wilkinson,David A %A Fayaz,Ahmed %A Littlejohn,Stuart %A Benschop,Jackie %+ Molecular Epidemiology and Public Health Laboratory, School of Veterinary Science, Massey University, Private Bag 11-222, Palmerston North, 4442, New Zealand, 64 6951 6918, s.nisa@massey.ac.nz %K leptospirosis %K Leptospira %K case-control study %K New Zealand %K mixed methods %K protocol %K Indigenous health %K public health %K One Health %D 2023 %7 8.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: In Aotearoa New Zealand, 90% of patients with notified leptospirosis (a zoonotic bacterial disease) have been men working in agricultural industries. However, since 2008, the epidemiology of notified cases has been gradually changing, that is, more women are affected; there are more cases associated with occupations traditionally not considered high risk in New Zealand; infecting serovars have changed; and many patients experience symptoms long after infection. We hypothesized that there is a shift in leptospirosis transmission patterns with substantial burden on affected patients and their families. Objective: In this paper, we aimed to describe the protocols used to conduct a nationwide case-control study to update leptospirosis risk factors and follow-up studies to assess the burden and sources of leptospirosis in New Zealand. Methods: This study used a mixed methods approach, comprising a case-control study and 4 substudies that involved cases only. Cases were recruited nationwide, and controls were frequency matched by sex and rurality. All participants were administered a case-control questionnaire (study 1), with cases being interviewed again at least 6 months after the initial survey (study 2). A subset of cases from two high-risk populations, that is, farmers and abattoir workers, were further engaged in a semistructured interview (study 3). Some cases with regular animal exposure had their in-contact animals (livestock for blood and urine and wildlife for kidney) and environment (soil, mud, and water) sampled (study 4). Patients from selected health clinics suspected of leptospirosis also had blood and urine samples collected (study 5). In studies 4 and 5, blood samples were tested using the microscopic agglutination test to test for antibody titers against Leptospira serovars Hardjo type bovis, Ballum, Tarassovi, Pomona, and Copenhageni. Blood, urine, and environmental samples were also tested for pathogenic Leptospira DNA using polymerase chain reaction. Results: Participants were recruited between July 22, 2019, and January 31, 2022, and data collection for the study has concluded. In total, 95 cases (July 25, 2019, to April 13, 2022) and 300 controls (October 19, 2019, to January 26, 2022) were interviewed for the case-control study; 91 cases participated in the follow-up interviews (July 9, 2020, to October 25, 2022); 13 cases participated in the semistructured interviews (January 26, 2021, to January 19, 2022); and 4 cases had their in-contact animals and environments sampled (October 28, 2020, and July 29, 2021). Data analysis for study 3 has concluded and 2 manuscripts have been drafted for review. Results of the other studies are being analyzed and the specific results of each study will be published as individual manuscripts.. Conclusions: The methods used in this study may provide a basis for future epidemiological studies of infectious diseases. International Registered Report Identifier (IRRID): DERR1-10.2196/47900 %M 37289491 %R 10.2196/47900 %U https://www.researchprotocols.org/2023/1/e47900 %U https://doi.org/10.2196/47900 %U http://www.ncbi.nlm.nih.gov/pubmed/37289491 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e43308 %T The Relationship Between Face Mask Use and Face-Touching Frequency in Public Areas: Naturalistic Study %A Niesen,Sydney %A Ramon,Daniel %A Spencer-Hwang,Rhonda %A Sinclair,Ryan %+ San Diego State University, 5500 Campanile Dr, San Diego, CA, 92182, United States, 1 6195945200, sydney.niesen@gmail.com %K COVID-19 %K mask wearing %K face-touching %K self-inoculation %K public health %K digital surveillance %K webcam video %K prevention %K health risk %K health %K risk %K mask %K surveillance %K transmission %K behavior %D 2023 %7 29.5.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: Throughout the COVID-19 pandemic in the United States, a major public health goal has been reducing the spread of the virus, with particular emphasis on reducing transmission from person to person. Frequent face touching can transmit viral particles from one infected person and subsequently infect others in a public area. This raises an important concern about the use of face masks and their relationship with face-touching behaviors. One concern discussed during the pandemic is that wearing a mask, and different types of masks, could increase face touching because there is a need to remove the mask to smoke, drink, eat, etc. To date, there have been few studies that have assessed this relationship between mask wearing and the frequency of face touching relative to face-touching behaviors. Objective: This study aimed to compare the frequency of face touching in people wearing a mask versus not wearing a mask in high–foot traffic urban outdoor areas. The purpose of this study was to assess if mask wearing was associated with increased face touching. Methods: Public webcam videos from 4 different cities in New York, New Jersey, Louisiana, and Florida were used to collect data. Face touches were recorded as pedestrians passed under the webcam. Adult pedestrians wearing masks were compared to those not wearing masks. Quantitative measures of frequency, duration, site of touch, and oral activities were recorded. Linear regression analysis was used to assess the association between mask use and face touching. Results: Of the 490 observed subjects, 241 (49.2%) were wearing a mask properly and 249 (50.8%) were not. In the unmasked group, 33.7% (84/249) were wearing it improperly, covering the mouth only. Face touching occurred in 11.4% (56/490) of the masked group and 17.6% (88/490) in the unmasked group. Of those who touched their face, 61.1% (88/144) of people were not wearing a mask. The most common site of face touching was the perioral region in both groups. Both the masked and unmasked group had a frequency of face touching for 0.03 touches/s. Oral activities such as eating or smoking increased face touching in the unmasked group. Conclusions: Contrary to expectations, non–mask-wearing subjects touched their face more frequently than those who were wearing a mask. This finding is substantial because wearing a face mask had a negative association with face touching. When wearing a mask, individuals are less likely to be spreading and ingesting viral particles. Therefore, wearing a mask is more effective in preventing the spread of viral particles. %M 37094229 %R 10.2196/43308 %U https://www.i-jmr.org/2023/1/e43308 %U https://doi.org/10.2196/43308 %U http://www.ncbi.nlm.nih.gov/pubmed/37094229 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e39022 %T Prevalence of Antibiotic-Resistant Pathogenic Bacteria and Level of Antibiotic Residues in Hospital Effluents in Selangor, Malaysia: Protocol for a Cross-sectional Study %A Bakon,Sophia Karen %A Mohamad,Zuraifah Asrah %A Jamilan,Mohd Azerulazree %A Hashim,Hazimah %A Kuman,Mohamed Yazid %A Shaharudin,Rafiza %A Ahmad,Norazah %A Muhamad,Nor Asiah %+ Environmental Health Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Persiaran Setia Murni, Setia Alam, Shah Alam, 40170, Malaysia, 60 +60333627774, sophia.karen@moh.gov.my %K ESKAPE %K antimicrobial resistance %K hospital effluent %K antibiotics %K health care %K antibiotic resistance %K antimicrobial %K hospital setting %K antibiotic residues %K wastewater %D 2023 %7 29.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Antimicrobial resistance (AMR) has emerged as a major global public health challenge due to the overuse and misuse of antibiotics for humans and animals. Hospitals are among the major users of antibiotics, thereby having a large contribution to AMR. Objective: The aim of this study is to determine the prevalence of antibiotic-resistant pathogenic bacteria and the level of antibiotic residues in the hospital effluents in Selangor, Malaysia. Methods: A cross-sectional study will be performed in the state of Selangor, Malaysia. Tertiary hospitals will be identified based on the inclusion and exclusion criteria. The methods are divided into three phases: sample collection, microbiological analysis, and chemical analysis. Microbiological analyses will include the isolation of bacteria from hospital effluents by culturing on selective media. Antibiotic sensitivity testing will be performed on the isolated bacteria against ceftriaxone, ciprofloxacin, meropenem, vancomycin, colistin, and piperacillin/tazobactam. The identification of bacteria will be confirmed using 16S RNA polymerase chain reaction (PCR) and multiplex PCR will be performed to detect resistance genes (ermB, mecA, blaNDM-L, blaCTX-M, blaOXA-48, blaSHV, VanA, VanB, VanC1, mcr-1, mcr-2, mcr-3, Intl1, Intl2, and qnrA). Finally, the level of antibiotic residues will be measured using ultrahigh-performance liquid chromatography. Results: The expected outcomes will be the prevalence of antibiotic-resistant Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter (ESKAPE) bacterial species from the hospital effluents, the occurrence of antibiotic resistance genes (ARGs) from the isolated ESKAPE bacteria, and the level of antibiotic residues that may be detected from the effluent. Sampling has been conducted in three hospitals. Data analysis from one hospital showed that as of July 2022, 80% (8/10) of E. faecium isolates were resistant to vancomycin and 10% (1/10) were resistant to ciprofloxacin. Further analysis will be conducted to determine if the isolates harbor any ARGs and effluent samples are being analyzed to detect antibiotic residues. Sampling activities will be resumed after being suspended due to the COVID-19 pandemic and are scheduled to end by December 2022. Conclusions: This study will provide the first baseline information to elucidate the current status of AMR of highly pathogenic bacteria present in hospital effluents in Malaysia. International Registered Report Identifier (IRRID): DERR1-10.2196/39022 %M 37247207 %R 10.2196/39022 %U https://www.researchprotocols.org/2023/1/e39022 %U https://doi.org/10.2196/39022 %U http://www.ncbi.nlm.nih.gov/pubmed/37247207 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40897 %T Patient-Centered Outcomes Associated With a Novel Office-Based Opioid Treatment Program in a District Health Department: Mixed Methods Pilot Study %A Coles,Theresa %A Chen,Hillary %A Des Marais,Andrea %A Sachdeva,Nidhi %A Bush,Christopher %A Macon Harrison,Lisa %A Guthrie,Shauna %+ Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St., Durham, NC, 27701, United States, 1 919 613 7994, theresa.coles@duke.edu %K integrated care %K mental health %K opioid treatment %K opioid use disorder %K opioid %K patient-centered outcomes %K public health %D 2023 %7 24.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Granville and Vance counties have some of the highest opioid-related death rates in North Carolina, and have significant unmet needs with regard to opioid treatment. Medication for opioid use disorder (MOUD) is the most effective evidence-based approach to address opioid use disorder. Despite demonstrated efficacy and substantial need, access to MOUD is still insufficient in many parts of the United States. In order to connect patients with needed MOUD services, the district health department, Granville Vance Public Health (GVPH), established an office-based opioid treatment (OBOT) program. Objective: In this formative pilot study, we sought to describe patients’ goals and outcomes in a program delivered at a rural local health department using an integrated care approach. Methods: We used a mixed methods concurrent nested research design. The primary method of investigation was one-on-one qualitative interviews with active OBOT patients (n=7) focused on patients’ goals and perceived impacts of the program. Trained interviewers followed a semistructured interview guide developed iteratively by the study team. The secondary method was a descriptive quantitative analysis (79 patients; 1478 visits over 2.5 years) of treatment retention and patient-reported outcomes (anxiety and depression). Results: Participants in the OBOT program were 39.6 years of age on average, and 25.3% (20/79) were uninsured. The average retention in the program was 18.4 months. The proportion of individuals in the program with moderate to severe depression (Patient Health Questionnaire-9 scores ≥10) decreased between program initiation (66%, 23/35) and at the most recent assessment (34%, 11/32). In qualitative interviews, participants credited the OBOT program for reducing or stopping the use of opioids and other substances (eg, marijuana, cocaine, and benzodiazepines). Many participants noted how the program helped them manage withdrawal symptoms and cravings, which helped them feel more in control of their use. Participants also attributed improvements in quality of life to the OBOT program, such as improved relationships with loved ones, improved mental and physical health, and improved financial stability. Conclusions: Initial data show promising patient outcomes for active GVPH OBOT participants, including reduction in opioid use and improvements in quality of life. As a pilot study, a limitation of this study is a lack of a comparison group. However, this formative project demonstrates promising patient-centered outcome improvements for GVPH OBOT participants. %M 37223963 %R 10.2196/40897 %U https://formative.jmir.org/2023/1/e40897 %U https://doi.org/10.2196/40897 %U http://www.ncbi.nlm.nih.gov/pubmed/37223963 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e41365 %T Face Mask Use and Associated Factors Among Students: Mixed Methods Study %A Addis Gesese,Abreha %A Duer Thot,Tut %+ Department of Clinical Nursing, Gambella Teachers Education and Health Science College, Gambella Town, Gambella, 113, Ethiopia, 251 949581901, abrhaddis09@gmail.com %K face mask use %K associated factors %K COVID-19 %K Gambella %K students %K Ethiopia %D 2023 %7 22.5.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: COVID-19 has gravely affected the world, including students, due to the high level of contracting infections. Objective: This study assessed the magnitude of mask use and associated factors among students. Methods: A cross-sectional study using mixed methods was conducted among students at Gambella Teachers’ Education and Health Science College, Gambella Region, Southwest Ethiopia, from March 5 to March 30, 2021. The stratified random sampling technique was used. Proportional allocation of samples was used to randomly select case teams, and a simple random sampling technique was used to recruit the students. The data were collected by trained and experienced enumerators. Data were entered into EpiData (version 3.1; EpiData Association) and exported to SPSS (version 22; IBM Corp) for analysis. Logistic regression was executed. The adjusted odds ratio (AOR) with the 95% CI was used to determine the association and strength with the outcome variable. The qualitative data were transcribed, translated, coded, and analyzed using thematic analysis. Then, the themes were used to triangulate the quantitative study. Results: The study included a total of 379 participants and yielded a response rate of 95.5% (379/397). The majority of study participants were older than 25 years, with the mean age being 26.34 (SD 5.8) years. This study found that the magnitude of mask use among students was 87% (330/379). The odds of mask use were higher among students who were female (AOR 3.32, 95% CI 1.191-9.248), younger (AOR 2.55, 95% CI 1.155-5.627), agreed that not all persons with COVID-19 develop severe disease (AOR 3.38, 95% CI 1.36-8.41), agreed that there is currently no effective cure (AOR 6.28, 95% CI 1.36-28.99), performed proper washing with soap and water (AOR 0.027, 95% CI 0.004-0.182), had started to stay home (AOR 0.168, 95% CI 0.054-0.52), agreed that COVID-19 is fatal (AOR 0.236, 95% CI 0.084-0.666), agreed that a flu vaccine is sufficient for COVID-19 prevention (AOR 3.874, 95% CI 1.540-9.749), and disinfected equipment and working areas at least once a day (AOR 0.222, 95% CI 0.086-0.575). Conclusions: This study found that the magnitude of mask use among students was relatively moderate in Ethiopia. Sex, age, agreeing that not all persons with COVID-19 develop severe disease, agreeing that there is currently no effective cure, performing proper washing with soap and water, starting to stay home, agreeing that COVID-19 is fatal, and agreeing that the flu vaccine is sufficient to prevent COVID-19 were independently associated with mask use among students. Therefore, colleges should aggressively encourage students to wear masks and monitor the implementation of COVID-19 prevention regulations along with the accessibility of masks. %M 37130014 %R 10.2196/41365 %U https://www.i-jmr.org/2023/1/e41365 %U https://doi.org/10.2196/41365 %U http://www.ncbi.nlm.nih.gov/pubmed/37130014 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e43712 %T Spatio-Temporal Analysis of Leptospirosis Hotspot Areas and Its Association With Hydroclimatic Factors in Selangor, Malaysia: Protocol for an Ecological Cross-sectional Study %A Ab Kadir,Muhammad Akram %A Abdul Manaf,Rosliza %A Mokhtar,Siti Aisah %A Ismail,Luthffi Idzhar %+ Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia, 60 397692404, rosliza_abmanaf@upm.edu.my %K leptospirosis %K hotspot areas %K hydroclimatic factors %K Selangor %K geographical information system %K GIS %K predictive model %D 2023 %7 15.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Leptospirosis is considered a neglected zoonotic disease in temperate regions but an endemic disease in countries with tropical climates such as South America, Southern Asia, and Southeast Asia. There has been an increase in leptospirosis incidence in Malaysia from 1.45 to 25.94 cases per 100,000 population between 2005 and 2014. With increasing incidence in Selangor, Malaysia, and frequent climate change dynamics, a study on the disease hotspot areas and their association with the hydroclimatic factors would further enhance disease surveillance and public health interventions. Objective: This study aims to examine the association between the spatio-temporal distribution of leptospirosis hotspot areas from 2011 to 2019 with the hydroclimatic factors in Selangor using the geographical information system and remote sensing techniques to develop a leptospirosis hotspot predictive model. Methods: This will be an ecological cross-sectional study with geographical information system and remote sensing mapping and analysis concerning leptospirosis using secondary data. Leptospirosis cases in Selangor from January 2011 to December 2019 shall be obtained from the Selangor State Health Department. Laboratory-confirmed cases with data on the possible source of infection would be identified and georeferenced according to their longitude and latitudes. Topographic data consisting of subdistrict boundaries and the distribution of rivers in Selangor will be obtained from the Department of Survey and Mapping. The ArcGIS Pro software will be used to evaluate the clustering of the cases and mapped using the Getis-Ord Gi* tool. The satellite images for rainfall and land surface temperature will be acquired from the Giovanni National Aeronautics and Space Administration EarthData website and processed to obtain the average monthly values in millimeters and degrees Celsius. Meanwhile, the average monthly river hydrometric levels will be obtained from the Department of Drainage and Irrigation. Data are then inputted as thematic layers and in the ArcGIS software for further analysis. The artificial neural network analysis in artificial intelligence Phyton software will then be used to obtain the leptospirosis hotspot predictive model. Results: This research was funded as of November 2022. Data collection, processing, and analysis commenced in December 2022, and the results of the study are expected to be published by the end of 2024. The leptospirosis distribution and clusters may be significantly associated with the hydroclimatic factors of rainfall, land surface temperature, and the river hydrometric level. Conclusions: This study will explore the associations of leptospirosis hotspot areas with the hydroclimatic factors in Selangor and subsequently the development of a leptospirosis predictive model. The constructed predictive model could potentially be used to design and enhance public health initiatives for disease prevention. International Registered Report Identifier (IRRID): PRR1-10.2196/43712 %M 37184897 %R 10.2196/43712 %U https://www.researchprotocols.org/2023/1/e43712 %U https://doi.org/10.2196/43712 %U http://www.ncbi.nlm.nih.gov/pubmed/37184897 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e44135 %T Creation of a Holistic Platform for Health Boosting Using a Blockchain-Based Approach: Development Study %A Lopez-Barreiro,Juan %A Alvarez-Sabucedo,Luis %A Garcia-Soidan,Jose-Luis %A Santos-Gago,Juan M %+ Faculty of Education and Sport Sciences, University of Vigo, Campus A Xunqueira, s/n, Pontevedra, 36005, Spain, 34 610669712, juan.lopez.barreiro@uvigo.es %K blockchain %K exercise %K gamification %K habits %K healthy lifestyle %K physical fitness %D 2023 %7 19.4.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: Low adherence to healthy habits, which is associated with a higher risk of disease and death, among citizens of Organization for Economic Co-operation and Development countries is a serious concern. The World Health Organization (WHO) and the physical activity (PA) guidelines for Americans provide recommendations on PA and healthy diets. To promote these habits, we suggest using a blockchain-based platform, using the PA Messaging Framework to deliver messages and rewards to users. Blockchain is a decentralized secure platform for data management, which can be used for value-added controls and services such as smart contracts (SCs), oracles, and decentralized applications (dApps). Of note, there is a substantial penetration of blockchain technologies in the field of PA, but there is a need for more implementations of dApps to take advantage of features such as nonfungible tokens. Objective: This study aimed to create a comprehensive platform for promoting healthy habits, using scientific evidence and blockchain technology. The platform will use gamification to encourage healthy PA and eating habits; in addition, it will monitor the activities through noninvasive means, evaluate them using open-source software, and follow up through blockchain messages. Methods: A literature search was conducted on the use of blockchain technology in the field of PA and healthy eating. On the basis of the results of this search, it is possible to define an innovative platform for promoting and monitoring healthy habits through health-related challenges on a dApp. Contact with the user will be maintained through messages following a proposed model in the literature to improve adherence to the challenges. Results: The proposed strategy is based on a dApp that relies on blockchain technology. The challenges include PA and healthy eating habits based on the recommendations of the WHO and the Food and Agriculture Organization. The system is constituted of a blockchain network where challenge-related achievements are stored and verified using SCs. The user interacts with the system through a dApp that runs on their local device, monitors the challenge, and self-authenticates by providing their public and private keys. The SC verifies challenge fulfillment and generates messages, and the information stored in the network can be used to encourage competition among participants. The ultimate goal is to create a habit of healthy activities through rewards and peer competition. Conclusions: The use of blockchain technology has the potential to improve people’s quality of life through the development of relevant services. In this work, strategies using gamification and blockchain are proposed for monitoring healthy activities, with a focus on transparency and reward allocation. The results are promising, but compliance with the General Data Protection Regulation is still a concern. Personal data are stored on personal devices, whereas challenge data are recorded on the blockchain. %M 37074766 %R 10.2196/44135 %U https://www.i-jmr.org/2023/1/e44135 %U https://doi.org/10.2196/44135 %U http://www.ncbi.nlm.nih.gov/pubmed/37074766 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e39455 %T Effects of Antidepressants on COVID-19 Outcomes: Retrospective Study on Large-Scale Electronic Health Record Data %A Rahman,Md Mahmudur %A Mahi,Atqiya Munawara %A Melamed,Rachel %A Alam,Mohammad Arif Ul %+ The Richard A Miner School of Computer & Information Sciences, University of Massachusetts, 220 Pawtucket St, Lowell, MA, 01854, United States, 1 978 934 1971, mohammadariful_alam@uml.edu %K causal inference %K treatment effect %K drug effect %K COVID-19 outcomes %K COVID-19 severity %K drug repurposing %K COVID-19 %K depression %K mental health %K data mining %K electronic health record %K machine learning %K antidepressant %K causal inference method %D 2023 %7 11.4.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: Antidepressants exert an anticholinergic effect in varying degrees, and various classes of antidepressants can produce a different effect on immune function. While the early use of antidepressants has a notional effect on COVID-19 outcomes, the relationship between the risk of COVID-19 severity and the use of antidepressants has not been properly investigated previously owing to the high costs involved with clinical trials. Large-scale observational data and recent advancements in statistical analysis provide ample opportunity to virtualize a clinical trial to discover the detrimental effects of the early use of antidepressants. Objective: We primarily aimed to investigate electronic health records for causal effect estimation and use the data for discovering the causal effects of early antidepressant use on COVID-19 outcomes. As a secondary aim, we developed methods for validating our causal effect estimation pipeline. Methods: We used the National COVID Cohort Collaborative (N3C), a database aggregating health history for over 12 million people in the United States, including over 5 million with a positive COVID-19 test. We selected 241,952 COVID-19–positive patients (age >13 years) with at least 1 year of medical history. The study included a 18,584-dimensional covariate vector for each person and 16 different antidepressants. We used propensity score weighting based on the logistic regression method to estimate causal effects on the entire data. Then, we used the Node2Vec embedding method to encode SNOMED-CT (Systematized Nomenclature of Medicine-Clinical Terms) medical codes and applied random forest regression to estimate causal effects. We used both methods to estimate causal effects of antidepressants on COVID-19 outcomes. We also selected few negatively effective conditions for COVID-19 outcomes and estimated their effects using our proposed methods to validate their efficacy. Results: The average treatment effect (ATE) of using any one of the antidepressants was −0.076 (95% CI −0.082 to −0.069; P<.001) with the propensity score weighting method. For the method using SNOMED-CT medical embedding, the ATE of using any one of the antidepressants was −0.423 (95% CI −0.382 to −0.463; P<.001). Conclusions: We applied multiple causal inference methods with novel application of health embeddings to investigate the effects of antidepressants on COVID-19 outcomes. Additionally, we proposed a novel drug effect analysis–based evaluation technique to justify the efficacy of the proposed method. This study offers causal inference methods on large-scale electronic health record data to discover the effects of common antidepressants on COVID-19 hospitalization or a worse outcome. We found that common antidepressants may increase the risk of COVID-19 complications and uncovered a pattern where certain antidepressants were associated with a lower risk of hospitalization. While discovering the detrimental effects of these drugs on outcomes could guide preventive care, identification of beneficial effects would allow us to propose drug repurposing for COVID-19 treatment. %M 36881541 %R 10.2196/39455 %U https://www.i-jmr.org/2023/1/e39455 %U https://doi.org/10.2196/39455 %U http://www.ncbi.nlm.nih.gov/pubmed/36881541 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e45382 %T Impact of Social Isolation, Physician-Patient Communication, and Self-perception on the Mental Health of Patients With Cancer and Cancer Survivors: National Survey Analysis %A Choudhury,Avishek %+ Industrial and Management Systems Engineering, Benjamin M Statler College of Engineering and Mineral Resources, West Virginia University, 1374 Evansdale Drive, 321 Engineering Sciences Building, Morgantown, WV, 26506, United States, 1 304 293 9431, avishek.choudhury@mail.wvu.edu %K cancer communication %K cancer stigma %K mental health %K social isolation %K cancer survivorship %K patient-centeredness %D 2023 %7 7.4.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: Cancer is perceived as a life-threatening, fear-inducing, and stigmatized disease. Most patients with cancer and cancer survivors commonly experience social isolation, negative self-perception, and psychological distress. The heavy toll that cancer takes on patients continues even after treatment. It is common for many patients with cancer to feel uncertain about their future. Some undergo anxiety, loneliness, and fear of getting cancer again. Objective: This study examined the impact of social isolation, self-perception, and physician-patient communication on the mental health of patients with cancer and cancer survivors. The study also explored the impact of social isolation and physician-patient communication on self-perception. Methods: This retrospective study used restricted data from the 2021 Health Information National Trends Survey (HINTS), which collected data from January 11, 2021, to August 20, 2021. We used the partial least squares structural equation modeling (PLS-SEM) method for data analysis. We checked for quadratic effects among all the paths connecting social isolation, poor physician-patient communication, mental health (measured using the 4-item Patient Health Questionnaire [PHQ-4]), and negative self-perception. The model was controlled for confounding factors such as respondents’ annual income, education level, and age. Bias-corrected and accelerated (BCA) bootstrap methods were used to estimate nonparametric CIs. Statistical significance was tested at 95% CI (2-tailed). We also conducted a multigroup analysis in which we created 2 groups. Group A consisted of newly diagnosed patients with cancer who were undergoing cancer treatment during the survey or had received cancer treatment within the last 12 months (receipt of cancer treatment during the COVID-19 pandemic). Group B consisted of respondents who had received cancer treatment between 5 and 10 years previously (receipt of cancer treatment before the COVID-19 pandemic). Results: The analysis indicated that social isolation had a quadratic effect on mental health, with higher levels of social isolation associated with worse mental health outcomes up to a certain point. Self-perception positively affected mental health, with higher self-perception associated with better mental health outcomes. In addition, physician-patient communication significantly indirectly affected mental health via self-perception. Conclusions: The findings of this study provide important insights into the factors that affect the mental health of patients with cancer. Our results suggest that social isolation, negative self-perception, and communication with care providers are significantly related to mental health in patients with cancer. %M 37027201 %R 10.2196/45382 %U https://www.i-jmr.org/2023/1/e45382 %U https://doi.org/10.2196/45382 %U http://www.ncbi.nlm.nih.gov/pubmed/37027201 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e41308 %T The Use of Digital Technology for COVID-19 Detection and Response Management in Indonesia: Mixed Methods Study %A Nur Aisyah,Dewi %A Lokopessy,Alfiano Fawwaz %A Naman,Maryan %A Diva,Haniena %A Manikam,Logan %A Adisasmito,Wiku %A Kozlakidis,Zisis %+ Department of Epidemiology and Public Health, Institute of Epidemiology and Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 (0)207 679 2000, logan.manikam.10@ucl.ac.uk %K COVID-19 %K Indonesia %K digital technology %K digital innovation %K digital health %K response management %K robot innovation %K decontamination %D 2023 %7 28.2.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: The COVID-19 pandemic has triggered a greater use of digital technologies as part of the health care response in many countries, including Indonesia. It is the world’s fourth-most populous nation and Southeast Asia’s most populous country, with considerable public health pressures. Objective: The aim of our study is to identify and review the use of digital health technologies in COVID-19 detection and response management in Indonesia. Methods: We conducted a literature review of publicly accessible information in technical and scientific journals, as well as news articles from September 2020 to August 2022 to identify the use case examples of digital technologies in COVID-19 detection and response management in Indonesia. Results: The results are presented in 3 groups, namely (1) big data, artificial intelligence, and machine learning (technologies for the collection or processing of data); (2) health care system technologies (acting at the public health level); and (3) COVID-19 screening, population treatment, and prevention population treatment (acting at the individual patient level). Some of these technologies are the result of government-academia-private sector collaborations during the pandemic, which represent a novel, multisectoral practice in Indonesia within the public health care ecosystem. A small number of the identified technologies pre-existed the pandemic but were upgraded and adapted for current needs. Conclusions: Digital technologies were developed in Indonesia during the pandemic, with a direct impact on supporting COVID-19 management, detection, response, and treatment. They addressed different areas of the technological spectrum and with different levels of adoption, ranging from local to regional to national. The indirect impact of this wave of technological creation and use is a strong foundation for fostering future multisectoral collaboration within the national health care system of Indonesia. %M 36623206 %R 10.2196/41308 %U https://www.i-jmr.org/2023/1/e41308 %U https://doi.org/10.2196/41308 %U http://www.ncbi.nlm.nih.gov/pubmed/36623206 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e40883 %T COVID-19 in Vietnam and Its Impact on Road Trauma: Retrospective Study Based on National Data %A Nguyen,Ba Tuan %A Blizzard,Christopher Leigh %A Palmer,Andrew %A Nguyen,Huu Tu %A Cong Quyet,Thang %A Tran,Viet %A Nelson,Mark %+ Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, 7000, Australia, 61 460918919, batuan.nguyen@utas.edu.au %K COVID-19 %K impact %K road trauma %K low- and middle-income country %K LMIC %K mortality %K pandemic %K trauma %K social distancing %K lockdown %K Vietnam %K disease %K policy %K deaths %D 2023 %7 6.2.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: Despite significant improvement in the last decade, road trauma remains a substantial contributor to deaths in Vietnam. The COVID-19 pandemic necessitated public health measures that had an unforeseen benefit on road trauma in high-income countries. We investigate if this reduction was also seen in a low- to middle-income country like Vietnam. Objective: Our aim was to investigate how the COVID-19 pandemic and the government policies implemented in response to it impacted road trauma fatalities in Vietnam. We also compared this impact to other government policies related to road trauma implemented in the preceding 14 years (2007-2020). Methods: COVID-19 data were extracted from the Vietnamese Ministry of Health database. Road traffic deaths from 2007 to 2021 were derived from the Vietnamese General Statistical Office. We used Stata software (version 17; StataCorp) for statistical analysis. Poisson regression modeling was used to estimate trends in road fatality rates based on annual national mortality data for the 2007-2021 period. The actual change in road traffic mortality in 2021 was compared with calculated figures to demonstrate the effect of COVID-19 on road trauma fatalities. We also compared this impact to other government policies that aimed to reduce traffic-related fatalities from 2007 to 2020. Results: Between 2007 and 2020, the number of annual road traffic deaths decreased by more than 50%, from 15.3 to 7 per 100,000 population, resulting in an average reduction of 5.4% per annum. We estimated that the road traffic mortality rate declined by 12.1% (95% CI 8.9-15.3%) in 2021 relative to this trend. The actual number of road trauma deaths fell by 16.4%. This reduction was largely seen from August to October 2021 when lockdown and social distancing measures were in force. Conclusions: In 2021, the road traffic–related death reduction in Vietnam was 3 times greater than the trend seen in the preceding 14 years. The public health response to the COVID-19 pandemic in Vietnam was associated with a third of this reduction. It can thus be concluded that government policies implemented to address the COVID-19 pandemic resulted in a 4.3% decrease in road traffic deaths in 2021. This has been observed in high-income countries, but we have demonstrated this for the first time in a low- and middle-income country. %M 36718815 %R 10.2196/40883 %U https://www.i-jmr.org/2023/1/e40883 %U https://doi.org/10.2196/40883 %U http://www.ncbi.nlm.nih.gov/pubmed/36718815 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e41144 %T Health System Resilience in the Eastern Mediterranean Region: Perspective on the Recent Lessons Learned %A Amiri,Mirwais %A Al Nsour,Mohannad %A Alonso-Garbayo,Alvaro %A Al Serouri,Abdulwahed %A Maiteh,Adna %A Badr,Elsheikh %+ Global Health Development, Eastern Mediterranean Public Health Network, Shmeisani, Abdallah Ben Abbas Street, Bldg No 42, Amman, 11196, Jordan, 962 792985349, mamiri@globalhealthdev.org %K health systems resilience %K resilience %K vulnerability %K public health %K Eastern Mediterranean Region countries %K COVID-19 %D 2022 %7 21.12.2022 %9 Viewpoint %J Interact J Med Res %G English %X Background: Public health has a pivotal role in strengthening resilience at individual, community, and system levels as well as building healthy communities. During crises, resilient health systems can effectively adapt in response to evolving situations and reduce vulnerability across and beyond the systems. To engage national, regional, and international public health entities and experts in a discussion of challenges hindering achievement of health system resilience (HSR) in the Eastern Mediterranean Region, the Eastern Mediterranean Public Health Network (EMPHNET) held its seventh regional conference in Amman, Jordan, between November 15 and 18, 2021, under the theme “Towards Resilient Health Systems in the Eastern Mediterranean: Breaking Barriers.” This viewpoint paper portrays the roundtable discussion of experts on the core themes of that conference. Objective: Our aim was to provide insights on lessons learned from the past and explore new opportunities to attain more resilient health systems to break current barriers. Methods: The roundtable brought together a panel of public health experts representing Field Epidemiology Training Programs (FETPs), Centers for Disease Control and Prevention in Atlanta, World Health Organization, EMPHNET, universities or academia, and research institutions at regional and global levels. To set the ground, the session began with four 10-12–minute presentations introducing the concept of HSR and its link to workforce development with an overall reflection on the matter and lessons learned through collective experiences. The presentations were followed by an open question and answer session to allow for an interactive debate among panel members and the roundtable audience. Results: The panel discussed challenges faced by health systems and lessons learned in times of the new public health threats to move toward more resilient health systems, overcome current barriers, and explore new opportunities to enhance the HSR. They presented field experiences in building resilient health systems and the role of FETPs with an example from Yemen FETP. Furthermore, they debated the lessons learned from COVID-19 response and how it can reshape our thinking and strategies for approaching HSR. Finally, the panel discussed how health systems can effectively adapt and prosper in the face of challenges and barriers to recover from extreme disruptions while maintaining the core functions of the health systems. Conclusions: Considering the current situation in the region, there is a need to strengthen both pandemic preparedness and health systems, through investing in essential public health functions including those required for all-hazards emergency risk management. Institutionalized mechanisms for whole-of-society engagement, strengthening primary health care approaches for health security and universal health coverage, as well as promoting enabling environments for research, innovation, and learning should be ensured. Investing in building epidemiological capacity through continuous support to FETPs to work toward strengthening surveillance systems and participating in regional and global efforts in early response to outbreaks is crucial. %M 36480685 %R 10.2196/41144 %U https://www.i-jmr.org/2022/2/e41144 %U https://doi.org/10.2196/41144 %U http://www.ncbi.nlm.nih.gov/pubmed/36480685 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e25886 %T The Use of Compression Stockings to Reduce Water Retention in the Legs During Gaming and Esports: Randomized Controlled Field Study %A Schmidt,Steffen Christian Ekkehard %A Sell,Stefan %A Woll,Alexander %+ Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, Karlsruhe, 76131, Germany, 49 176 24569222, steffen.schmidt@kit.edu %K esport %K streaming %K gaming %K water retention %K fluid balance %K compression stockings %K bioelectrical impedance %K mobile phone %D 2022 %7 29.9.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: With the increasing digitalization of daily life, internet-based entertainment such as gaming and streaming has advanced to one of the megatrends of the 21st century. Besides offering a multitude of controversially discussed opportunities for entertainment and social interaction, there is reasonable concern about health issues caused by the absence of physical activity among activities linked to gaming and streaming. Objective: The aim of this study is to compare the water balance of recreational gamers with and those without compression stockings during a gaming event. Methods: We measured body composition and water balance with 8-electrode bioelectrical impedance analysis among 46 recreational gamers with an average age of 27.1 (SD 6.5) years (5/46, 11% women and 41/46, 89% men) before and after 24 hours at a gaming event. Of the 46 gamers, 23 (50%) gamers wore compression stockings for the duration of the study. Results: Our study shows that prolonged gaming and associated behaviors during a 24-hour time frame lead to an increase in total body water (+0.76 L; P<.001) and a decrease of phase angle in the lower extremities (−0.47°; P<.001) but not in the upper extremities (+0.09°; P=.80), when no compression is used. Gamers using compression socks did not show any significant negative effects on their body composition. Conclusions: Prolonged gaming and streaming are serious risk factors for diseases associated with water retention in the legs, and these risks can be measured by bioelectrical impedance and reduced by wearing compression stockings. We conclude that these findings should be discussed and replicated in larger studies and that there is a considerably large market for compression stockings among gamers and live streamers. %M 36173666 %R 10.2196/25886 %U https://www.i-jmr.org/2022/2/e25886 %U https://doi.org/10.2196/25886 %U http://www.ncbi.nlm.nih.gov/pubmed/36173666 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e34268 %T Factors Influencing the Adoption of Voluntary Nonpharmaceutical Interventions to Control COVID-19 in Japan: Cross-sectional Study %A Kuroki,Makoto %A Yamamoto,Kiyoshi %A Goldfinch,Shaun %+ Australia New Zealand School of Government, PO box 230, Carlton South, Victoria, Melbourne, 3053, Australia, 61 466 949 289, shaun.goldfinch@curtin.edu.au %K COVID-19 %K nonpharmaceutical interventions %K social distancing %K phone tracing %K trust in government %K confidence in scientists %D 2022 %7 2.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Trust in government is seen to facilitate crisis management and policy instrument adoption across numerous studies. However, in Japan, public support for government handling of the COVID-19 pandemic and trust in the government is low, yet the adoption of voluntary nondigital nonpharmaceutical interventions (NPIs) is high. This is an important tension this study seeks to unravel. Objective: The aim of this study is to understand the antecedents of nondigital NPI and tracking app adoption in the COVID-19 pandemic in Japan. Methods: A commercial company was contracted to deliver an online survey of 1248 Japanese citizens in December 2020. A quota technique was used to deliver a sample representative in terms of gender, age, residence, income, and education. Results: The adoption of voluntary nondigital NPIs is predicted by confidence in public health scientists and a favoring of infection control over reducing economic and social costs. A novel and unexpected finding is that trust in government does not predict nondigital NPI use. Perceived risk and knowledge of infection did not increase the use of nondigital NPIs. Education and income were not significant factors, although female and older respondents demonstrated greater compliance. For the adoption of a phone tracking app, trust in government is important, as is urban residence, albeit with a lower use of the app compared to nondigital NPIs. Conclusions: Voluntary compliance in the adoption of nondigital NPIs—if skillfully led by trusted scientific experts and in accord with societal norms—can be effectively achieved. We provide evidence that trust in government is effective in encouraging the use of the Japanese tracking app. Moreover, the technical efficacy of digital initiatives and perceptions of such will unsurprisingly affect citizen support and use of digital tools. %M 35916697 %R 10.2196/34268 %U https://formative.jmir.org/2022/8/e34268 %U https://doi.org/10.2196/34268 %U http://www.ncbi.nlm.nih.gov/pubmed/35916697 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 3 %N 2 %P e32859 %T Cognitive Factors Associated With Public Acceptance of COVID-19 Nonpharmaceutical Prevention Measures: Cross-sectional Study %A Constant,Aymery %A Conserve,Donaldson %A Gallopel-Morvan,Karine %A Raude,Jocelyn %+ Ecole des Hautes Etudes en Santé Publique, 15 Avenue du Prof Leon Bernard, Rennes, 35043, France, 33 2 99 02 25 93, Aymery.constant@ehesp.Fr %K Extended Parallel Process Model %K COVID-19 %K lockdown %K public acceptance %K nonpharmaceutical measures %K Likert scale %K France %D 2022 %7 13.5.2022 %9 Original Paper %J JMIRx Med %G English %X Background: During the COVID-19 crisis, protests against restrictions emerged and rule violations increased, provoking peaks in new positive cases, forcing authorities in France to impose fines to slow down the spread of the disease. Due to these challenges, subsequent implementations of preventive measures in response to COVID-19 recurrences or other pandemics could present difficulties for decision makers. A better understanding of the factors underlying the public acceptance of COVID-19 nonpharmaceutical preventive measures may therefore contribute greatly to the design of more effective public communication during future pandemics. Objective: The aim of this study was to evaluate the acceptance of COVID-19 nonpharmaceutical prevention measures in France. The specific objectives were (1) to examine the public’s acceptance of COVID-19 nonpharmaceutical prevention measures and (2) to assess the association of the public’s acceptance of these prevention measures and their perception of COVID-19. Methods: Data were collected from 2004 individuals through an online survey conducted 6-8 weeks after the first lockdown in France. For objective 1, participants were asked the extent to which they supported 8 COVID-19 nonpharmaceutical preventive measures using a 4-point Likert scale. For objective 2, COVID-19–related perceptions were assessed using a 5-point Likert scale from an adapted version of Witte’s Extended Parallel Process Model. Sociodemographic and environmental variables were also collected. The public’s acceptance factors were estimated using an unweighted least squares factorial analysis, and their associations with perceptions of COVID-19, expressed as rate ratios (RR) and 95% CIs, were estimated using generalized linear Poisson regression models. Statistical analyses were performed using the SPSS statistical package. Results: The acceptance rate reached 86.1% for individual protective measures, such as making masks mandatory in public open spaces, and 70.0% for collective restrictions, such as isolating the most vulnerable people (1604/2004, 80%) or forbidding public gatherings (n=1590, 79.3%). The least popular restrictions were closing all schools/universities and nonessential commerce such as bars and restaurants (n=1146, 57.2%). Acceptance of collective restrictions was positively associated with their perceived efficacy (RR 1.02, 95% CI 1.01-1.03), fear of COVID-19 (RR 1.04, 95% CI 1.03-1.05), and perceived severity of COVID-19 (RR 1.04, 95% CI 1.03-1.06), and negatively with age >60 years (RR 0.89, 95% CI 0.81-0.98). Acceptance of individual protective measures was associated with their perceived efficacy (RR 1.03, 95% CI 1.03-1.04), fear of COVID-19 (RR 1.02, 1.01-1.03), and perceived severity of COVID-19 (RR 1.03, 1.01-1.05). Conclusions: Acceptance rates of COVID-19 nonpharmaceutical measures were rather high, but varied according to their perceived social cost, and were more related to collective than personal protection. Nonpharmaceutical measures that minimize social costs while controlling the spread of the disease are more likely to be accepted during pandemics. %M 35648730 %R 10.2196/32859 %U https://med.jmirx.org/2022/2/e32859 %U https://doi.org/10.2196/32859 %U http://www.ncbi.nlm.nih.gov/pubmed/35648730 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e35969 %T Developing Reporting Guidelines for Studies of HIV Drug Resistance Prevalence: Protocol for a Mixed Methods Study %A Garcia,Cristian %A Rehman,Nadia %A Lawson,Daeria O %A Djiadeu,Pascal %A Mbuagbaw,Lawrence %+ Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada, 1 905 522 1155 ext 35929, mbuagblc@mcmaster.ca %K HIV %K drug resistance %K reporting guideline %K prevalence %K surveillance %K antiretroviral therapy %K report %K global health %K problem %K antiretroviral therapy %D 2022 %7 13.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: HIV drug resistance is a global health problem that limits the effectiveness of antiretroviral therapy. Adequate surveillance of HIV drug resistance is challenged by heterogenous and inadequate data reporting, which compromises the accuracy, interpretation, and usability of prevalence estimates. Previous research has found that the quality of reporting in studies of HIV drug resistance prevalence is low, and thus better guidance is needed to ensure complete and uniform reporting. Objective: This paper contributes to the process of developing reporting guidelines for prevalence studies of HIV drug resistance by reporting the methodology used in creating a reporting item checklist and generating key insights on items that are important to report. Methods: We will conduct a sequential explanatory mixed methods study among authors and users of studies of HIV drug resistance. The two-phase design will include a cross-sectional electronic survey (quantitative phase) followed by a focus group discussion (qualitative phase). Survey participants will rate the essentiality of various reporting items. This data will be analyzed using content validity ratios to determine the items that will be retained for focus group discussions. Participants in these discussions will revise the items and any additionally suggested items and settle on a complete reporting item checklist. We will also conduct a thematic analysis of the group discussions to identify emergent themes regarding the agreement process. Results: As of November 2021, data collection for both phases of the study is complete. In July 2021, 51 participants had provided informed consent and completed the electronic survey. In October 2021, focus group discussions were held. Nine participants in total participated in two virtual focus group discussions. As of May 2022, data are being analyzed. Conclusions: This study supports the development of a reporting checklist for studies of HIV drug resistance by achieving agreement among experts on what items should be reported in these studies. The results of this work will be refined and elaborated on by a writing committee of HIV drug resistance experts and external reviewers to develop finalized reporting guidelines. International Registered Report Identifier (IRRID): DERR1-10.2196/35969 %M 35559984 %R 10.2196/35969 %U https://www.researchprotocols.org/2022/5/e35969 %U https://doi.org/10.2196/35969 %U http://www.ncbi.nlm.nih.gov/pubmed/35559984 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 5 %P e35422 %T Clustering Diagnoses From 58 Million Patient Visits in Finland Between 2015 and 2018 %A Fränti,Pasi %A Sieranoja,Sami %A Wikström,Katja %A Laatikainen,Tiina %+ Machine Learning Group, School of Computing, University of Eastern Finland, Box 111, Joensuu, 80101, Finland, 358 405929966, samisi@cs.uef.fi %K multimorbidity %K cluster analysis %K disease co-occurrence %K multimorbidity network %K health care data analysis %K graph clustering %K k-means %K data analysis %K cluster %K machine learning %K comorbidity %K register %K big data %K Finland %K Europe %K health record %D 2022 %7 4.5.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Multiple chronic diseases in patients are a major burden on the health service system. Currently, diseases are mostly treated separately without paying sufficient attention to their relationships, which results in the fragmentation of the care process. The better integration of services can lead to the more effective organization of the overall health care system. Objective: This study aimed to analyze the connections between diseases based on their co-occurrences to support decision-makers in better organizing health care services. Methods: We performed a cluster analysis of diagnoses by using data from the Finnish Health Care Registers for primary and specialized health care visits and inpatient care. The target population of this study comprised those 3.8 million individuals (3,835,531/5,487,308, 69.90% of the whole population) aged ≥18 years who used health care services from the years 2015 to 2018. They had a total of 58 million visits. Clustering was performed based on the co-occurrence of diagnoses. The more the same pair of diagnoses appeared in the records of the same patients, the more the diagnoses correlated with each other. On the basis of the co-occurrences, we calculated the relative risk of each pair of diagnoses and clustered the data by using a graph-based clustering algorithm called the M-algorithm—a variant of k-means. Results: The results revealed multimorbidity clusters, of which some were expected (eg, one representing hypertensive and cardiovascular diseases). Other clusters were more unexpected, such as the cluster containing lower respiratory tract diseases and systemic connective tissue disorders. The annual cost of all clusters was €10.0 billion, and the costliest cluster was cardiovascular and metabolic problems, costing €2.3 billion. Conclusions: The method and the achieved results provide new insights into identifying key multimorbidity groups, especially those resulting in burden and costs in health care services. %M 35507390 %R 10.2196/35422 %U https://medinform.jmir.org/2022/5/e35422 %U https://doi.org/10.2196/35422 %U http://www.ncbi.nlm.nih.gov/pubmed/35507390 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 3 %N 2 %P e31521 %T Patterns of Physical Activity Among University Students and Their Perceptions About the Curricular Content Concerned With Health: Cross-sectional Study %A Verma,Arun Kumar %A Singh,Girish %A Patwardhan,Kishor %+ Department of Kriya Sharir, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, C/1, New Medical Enclave, Banaras Hindu University, Varanasi, 221005, India, 91 9415290426, kpatwardhan@bhu.ac.in %K physical activity %K university students %K university %K exercise %K students %K inactive %K curricula %K healthy lifestyle %K higher education %D 2022 %7 29.4.2022 %9 Original Paper %J JMIRx Med %G English %X Background: University students are at risk of losing their focus on maintaining healthy levels of physical activity because of their engagements with curricular and cocurricular activities. In India, the physical activity levels of the adult population have been reported to be declining in the recent years. However, studies focusing on university students pertaining to their physical activity are lacking in the Indian context. Moreover, a question that has not been properly addressed is the following: “do the curricula in higher education promote physical activity?” Objective: Our paper aims at describing the physical activity levels of the students in a large public-funded central university located in northern India. The study also aims at capturing the student perceptions about the emphasis they receive on leading a physically active lifestyle during their routine curricular activities. Methods: This is a cross-sectional descriptive study and uses International Physical Activity Questionnaire—Long Form to record physical activity among 4586 students. Stratified sampling method was used to enroll the students from each stream (faculty). Out of 30,667 students, about 15% were included from each faculty. The study was conducted between 2016 and 2019. To capture the student perceptions, we used a newly developed 5-item scale. Results: From a total of 4586 participants in the study, 2828 (61.7%) were male and 1758 (38.3%) were female students. The mean age of our sample was 22.34 (SD 3.12) years. Our results indicate that about 14.5% (n=666) of all students in the study fall under the “Inactive” category. Furthermore, the perception about the curricular content pertaining to physical activity varied widely between the students of different streams. Conclusions: Our sample reported a better physical activity pattern in comparison to the reported overall physical activity levels of the adult population of India. Our results also suggest that health-related topics are inadequately represented in many of the streams of higher education in the university. %M 37725547 %R 10.2196/31521 %U https://med.jmirx.org/2022/2/e31521 %U https://doi.org/10.2196/31521 %U http://www.ncbi.nlm.nih.gov/pubmed/37725547 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e33656 %T Agreement Between Self-reports and Photos to Assess e-Cigarette Device and Liquid Characteristics in Wave 1 of the Vaping and Patterns of e-Cigarette Use Research Study: Web-Based Longitudinal Cohort Study %A Crespi,Elizabeth %A Hardesty,Jeffrey J %A Nian,Qinghua %A Sinamo,Joshua %A Welding,Kevin %A Kennedy,Ryan David %A Cohen,Joanna E %+ Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street, Baltimore, MD, 21205, United States, 1 410 614 5378, ecrespi2@jhu.edu %K tobacco %K e-cigarette %K methodology %K internet %K photo %K survey %K self-report %D 2022 %7 27.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: e-Cigarette device and liquid characteristics are highly customizable; these characteristics impact nicotine delivery and exposure to toxic constituents. It is critical to understand optimal methods for measuring these characteristics to accurately assess their impacts on user behavior and health. Objective: To inform future survey development, we assessed the agreement between responses from survey participants (self-reports) and photos uploaded by participants and the quantity of usable data derived from each approach. Methods: Adult regular e-cigarette users (≥5 days per week) aged ≥21 years (N=1209) were asked questions about and submitted photos of their most used e-cigarette device (1209/1209, 100%) and liquid (1132/1209, 93.63%). Device variables assessed included brand, model, reusability, refillability, display, and adjustable power. Liquid variables included brand, flavor, nicotine concentration, nicotine formulation, and bottle size. For each variable, percentage agreement was calculated where self-report and photo data were available. Krippendorff α and intraclass correlation coefficient (ICC) were calculated for categorical and continuous variables, respectively. Results were stratified by device (disposable, reusable with disposable pods or cartridges, and reusable with refillable pods, cartridges, or tanks) and liquid (customized and noncustomized) type. The sample size for each calculation ranged from 3.89% (47/1209; model of disposable devices) to 95.12% (1150/1209; device reusability). Results: Percentage agreement between photos and self-reports was substantial to very high across device and liquid types for all variables except nicotine concentration. These results are consistent with Krippendorff α calculations, except where prevalence bias was suspected. ICC results for nicotine concentration and bottle size were lower than percentage agreement, likely because ICC accounts for the level of disagreement between values. Agreement varied by device and liquid type. For example, percentage agreement for device brand was higher among users of reusable devices (94%) than among users of disposable devices (75%). Low percentage agreement may result from poor participant knowledge of characteristics, user modifications of devices inconsistent with manufacturer-intended use, inaccurate or incomplete information on websites, or photo submissions that are not a participant’s most used device or liquid. The number of excluded values (eg, self-report was “don’t know” or no photo submitted) differed between self-reports and photos; for questions asked to participants, self-reports had more usable data than photos for all variables except device model and nicotine formulation. Conclusions: Photos and self-reports yield data of similar accuracy for most variables assessed in this study: device brand, device model, reusability, adjustable power, display, refillability, liquid brand, flavor, and bottle size. Self-reports provided more data for all variables except device model and nicotine formulation. Using these approaches simultaneously may optimize data quantity and quality. Future research should examine how to assess nicotine concentration and variables not included in this study (eg, wattage and resistance) and the resource requirements of these approaches. %M 35475727 %R 10.2196/33656 %U https://www.jmir.org/2022/4/e33656 %U https://doi.org/10.2196/33656 %U http://www.ncbi.nlm.nih.gov/pubmed/35475727 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e29088 %T Effectiveness of Web-Based Personalized Nutrition Advice for Adults Using the eNutri Web App: Evidence From the EatWellUK Randomized Controlled Trial %A Zenun Franco,Rodrigo %A Fallaize,Rosalind %A Weech,Michelle %A Hwang,Faustina %A Lovegrove,Julie A %+ Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, University of Reading, Whiteknights, Reading, RG6 6DZ, United Kingdom, 44 0118 378 6418, j.a.lovegrove@reading.ac.uk %K personalized nutrition %K web-based %K nutrition app %K app %K dietary intervention %K eNutri %K precision nutrition %K mHealth %K healthy eating index %K diet quality scores %K FFQ %K food frequency questionnaire %K EatWellUK %D 2022 %7 25.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Evidence suggests that eating behaviors and adherence to dietary guidelines can be improved using nutrition-related apps. Apps delivering personalized nutrition (PN) advice to users can provide individual support at scale with relatively low cost. Objective: This study aims to investigate the effectiveness of a mobile web app (eNutri) that delivers automated PN advice for improving diet quality, relative to general population food-based dietary guidelines. Methods: Nondiseased UK adults (aged >18 years) were randomized to PN advice or control advice (population-based healthy eating guidelines) in a 12-week controlled, parallel, single-blinded dietary intervention, which was delivered on the web. Dietary intake was assessed using the eNutri Food Frequency Questionnaire (FFQ). An 11-item US modified Alternative Healthy Eating Index (m-AHEI), which aligned with UK dietary and nutritional recommendations, was used to derive the automated PN advice. The primary outcome was a change in diet quality (m-AHEI) at 12 weeks. Participant surveys evaluated the PN report (week 12) and longer-term impact of the PN advice (mean 5.9, SD 0.65 months, after completion of the study). Results: Following the baseline FFQ, 210 participants completed at least 1 additional FFQ, and 23 outliers were excluded for unfeasible dietary intakes. The mean interval between FFQs was 10.8 weeks. A total of 96 participants were included in the PN group (mean age 43.5, SD 15.9 years; mean BMI 24.8, SD 4.4 kg/m2) and 91 in the control group (mean age 42.8, SD 14.0 years; mean BMI 24.2, SD 4.4 kg/m2). Compared with that in the control group, the overall m-AHEI score increased by 3.5 out of 100 (95% CI 1.19-5.78) in the PN group, which was equivalent to an increase of 6.1% (P=.003). Specifically, the m-AHEI components nuts and legumes and red and processed meat showed significant improvements in the PN group (P=.04). At follow-up, 64% (27/42) of PN participants agreed that, compared with baseline, they were still following some (any) of the advice received and 31% (13/42) were still motivated to improve their diet. Conclusions: These findings suggest that the eNutri app is an effective web-based tool for the automated delivery of PN advice. Furthermore, eNutri was demonstrated to improve short-term diet quality and increase engagement in healthy eating behaviors in UK adults, as compared with population-based healthy eating guidelines. This work represents an important landmark in the field of automatically delivered web-based personalized dietary interventions. Trial Registration: ClinicalTrials.gov NCT03250858; https://clinicaltrials.gov/ct2/show/NCT03250858 %M 35468093 %R 10.2196/29088 %U https://www.jmir.org/2022/4/e29088 %U https://doi.org/10.2196/29088 %U http://www.ncbi.nlm.nih.gov/pubmed/35468093 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 3 %N 2 %P e35862 %T COVID-19 Return to Sport: NFL Injury Prevalence Analysis %A Puga,Troy B %A Schafer,Joshua %A Agbedanu,Prince N %A Treffer,Kevin %+ College of Osteopathic Medicine, Kansas City University, 1750 Independence Ave, Kansas City, MO, 64106, United States, 1 719 821 9272, troy.puga@kansascity.edu %K COVID-19 %K sport %K injury %K prevalence %K cause %K data %K statistics %K pain %K training %K practice %K physiology %K adaptation %D 2022 %7 22.4.2022 %9 Original Paper %J JMIRx Med %G English %X Background: Sport injuries have been common among athletes across the globe for decades and have the potential to disrupt athletic careers, performance, and psyche. Many health professionals and organizations have undertaken injury mitigation strategies to prevent sport injuries through protective equipment, training protocols, and a host of other evidence-based practices. Many of these specialized training methods were disrupted due to protocols to mitigate the spread of COVID-19. This research examines the effects of the COVID-19 pandemic in relation to the prevalence of athletic injuries in the National Football League (NFL). Objective: During the COVID-19 pandemic, NFL teams and athletes across all levels of sport were reported to have reduced training in preparation for their seasons due to protocols to mitigate the spread of COVID-19. This study compares the prevalence of injury during the 2018, 2019, and 2020 NFL seasons, with the aim to determine the potential causes of the differences in injury prevalence. Methods: Official injury reports from each team were counted during the 17-week regular season of each year (2018, 2019, and 2020). The data were analyzed using an unpaired t test to compare the injury prevalence between each of the three seasons. Results: The 2018 season produced a total of 1561 injuries and a mean of 48.8 injuries per team. The 2019 season produced a total of 1897 injuries and a mean of 59.3 injuries per team, while the 2020 season produced a total of 2484 injuries and a mean of 77.6 injuries per team. An unpaired t test was performed using the data to compare the mean number of injuries per team during each of the seasons. Comparison of the 2020 season against the 2019 season showed a statistically significant difference (P<.001); comparison of the 2020 season to the 2018 season found a statistically significant difference (P<.001); and comparison between the 2019 and the 2018 seasons found a statistically significant difference (P=.03). Conclusions: Although the 2019 and 2018 seasons showed a statistically significant difference (P=.03), this difference is not as large when we compare the 2020 seasons versus the 2019 (P<.001) and 2018 (P<.001) seasons. The astronomical increase in injury prevalence during the 2020 season over the previous years raises the possibility that there was a reduced physiological adaptation to stress, due to the limited amount of training as a result of the closure of practice facilities in order to slow the spread of COVID-19. %M 35511457 %R 10.2196/35862 %U https://med.jmirx.org/2022/2/e35862 %U https://doi.org/10.2196/35862 %U http://www.ncbi.nlm.nih.gov/pubmed/35511457 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e31923 %T Conversational Agents in Health Education: Protocol for a Scoping Review %A Powell,Leigh %A Nizam,Mohammed Zayan %A Nour,Radwa %A Zidoun,Youness %A Sleibi,Randa %A Kaladhara Warrier,Sreelekshmi %A Al Suwaidi,Hanan %A Zary,Nabil %+ Institute for Excellence in Health Professions Education, Mohammed Bin Rashid University of Medicine and Health Sciences, Building 14, Dubai Healthcare City, PO Box 505055, Dubai, United Arab Emirates, 971 585960762, nabil.zary@mbru.ac.ae %K conversational agents %K artificial intelligence chatbots %K chatbots %K health education %K health promotion %K classification %K artificial intelligence assistants %K conversational artificial intelligence %D 2022 %7 19.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Conversational agents have the ability to reach people through multiple mediums, including the online space, mobile phones, and hardware devices like Alexa and Google Home. Conversational agents provide an engaging method of interaction while making information easier to access. Their emergence into areas related to public health and health education is perhaps unsurprising. While the building of conversational agents is getting more simplified with time, there are still requirements of time and effort. There is also a lack of clarity and consistent terminology regarding what constitutes a conversational agent, how these agents are developed, and the kinds of resources that are needed to develop and sustain them. This lack of clarity creates a daunting task for those seeking to build conversational agents for health education initiatives. Objective: This scoping review aims to identify literature that reports on the design and implementation of conversational agents to promote and educate the public on matters related to health. We will categorize conversational agents in health education in alignment with current classifications and terminology emerging from the marketplace. We will clearly define the variety levels of conversational agents, categorize currently existing agents within these levels, and describe the development models, tools, and resources being used to build conversational agents for health care education purposes. Methods: This scoping review will be conducted by employing the Arksey and O’Malley framework. We will also be adhering to the enhancements and updates proposed by Levac et al and Peters et al. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews will guide the reporting of this scoping review. A systematic search for published and grey literature will be undertaken from the following databases: (1) PubMed, (2) PsychINFO, (3) Embase, (4) Web of Science, (5) SCOPUS, (6) CINAHL, (7) ERIC, (8) MEDLINE, and (9) Google Scholar. Data charting will be done using a structured format. Results: Initial searches of the databases retrieved 1305 results. The results will be presented in the final scoping review in a narrative and illustrative manner. Conclusions: This scoping review will report on conversational agents being used in health education today, and will include categorization of the levels of the agents and report on the kinds of tools, resources, and design and development methods used. International Registered Report Identifier (IRRID): DERR1-10.2196/31923 %M 35258006 %R 10.2196/31923 %U https://www.researchprotocols.org/2022/4/e31923 %U https://doi.org/10.2196/31923 %U http://www.ncbi.nlm.nih.gov/pubmed/35258006 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 3 %N 2 %P e30144 %T Modeling Years of Life Lost Due to COVID-19, Socioeconomic Status, and Nonpharmaceutical Interventions: Development of a Prediction Model %A John,Jari %+ Institute of Political Science, University of Heidelberg, Bergheimer Str. 58, Heidelberg, 69115, Germany, 49 1636057958, jari.john@uni-heidelberg.de %K COVID-19 %K pandemic %K socioeconomic status %K mortality %K nonpharmaceutical interventions %K prediction model %K low-income status %K life expectancy %K public health %K income groups %D 2022 %7 12.4.2022 %9 Original Paper %J JMIRx Med %G English %X Background: Research in the COVID-19 pandemic focused on the health burden, thereby largely neglecting the potential harm to life from welfare losses. Objective: This paper develops a model that compares the years of life lost (YLL) due to COVID-19 and the potential YLL due to the socioeconomic consequences of its containment. Methods: It improves on existing estimates by conceptually disentangling YLL due to COVID-19 and socioeconomic status. By reconciling the normative life table approach with socioeconomic differences in life expectancy, it accounts for the fact that people with low socioeconomic status are hit particularly hard by the pandemic. The model also draws on estimates of socioeconomic differences in life expectancy to ascertain potential YLL due to income loss, school closures, and extreme poverty. Results: Tentative results suggest that if only one-tenth of the current socioeconomic damage becomes permanent in the future, it may carry a higher YLL burden than COVID-19 in the more likely pandemic scenarios. The model further suggests that the socioeconomic harm outweighs the disease burden due to COVID-19 more quickly in poorer and more unequal societies. Most urgently, the substantial increase in extreme poverty needs immediate attention. Avoiding a relatively minor number of 4 million unemployed, 1 million extremely poor, and 2 million students with a higher learning loss may save a similar amount of life years as saving 1 million people from dying from COVID-19. Conclusions: Primarily, the results illustrate the urgent need for redistributive policy interventions and global solidarity. In addition, the potentially high YLL burden from income and learning losses raises the burden of proof for the efficacy and necessity of school and business closures in the containment of the pandemic, especially where social safety nets are underdeveloped. %M 35438949 %R 10.2196/30144 %U https://med.jmirx.org/2022/2/e30144 %U https://doi.org/10.2196/30144 %U http://www.ncbi.nlm.nih.gov/pubmed/35438949 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e36357 %T Community Opioid Dispensing After Injury (CODI): Protocol for a Population-Based Data Linkage Study %A Cameron,Cate M %A McCreanor,Victoria %A Shibl,Rania %A Smyth,Tanya %A Proper,Melanie %A Warren,Jacelle %A Vallmuur,Kirsten %A Bradford,Natalie %A Carter,Hannah %A Graves,Nicholas %A Loveday,Bill %+ Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Metro North Health, Butterfield Street, Brisbane, QLD 4029, Australia, 61 0401034179, cate.cameron@health.qld.gov.au %K opioids %K injury %K data linkage %K cohort study %K outcomes %K epidemiology %K population-based study %K health records %D 2022 %7 12.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is an urgent need to reduce preventable deaths and hospitalizations from prescription opioid harms and minimize the negative effect opioid misuse can have on injured individuals, families, and the wider community. Data linkage between administrative hospitalization records for injured patients and community opioid dispensing can improve our understanding of the health and surgical trajectories of injured persons and generate insights into corresponding opioid dispensing patterns. Objective: The Community Opioid Dispensing after Injury (CODI) study aims to link inpatient hospitalization data with opioid dispensing data to examine the distribution and predictive factors associated with high or prolonged community opioid dispensing among adults, for 2 years following an injury-related hospital admission. Methods: This is a retrospective population-based cohort study of adults aged 18 years or older hospitalized with an injury in Queensland, Australia. The study involves the linkage of statewide hospital admissions, opioid prescription dispensing, and mortality data collections. All adults hospitalized for an injury between January 1, 2014, and December 31, 2015, will be included in the cohort. Demographics and injury factors are recorded at the time of the injury admission. Opioid dispensing data will be linked and extracted for 3 months prior to the injury admission date to 2 years after the injury separation date (last date December 31, 2017). Deaths data will be extracted for the 2-year follow-up period. The primary outcome measure will be opioid dispensing (frequency and quantity) in the 2 years following the injury admission. Patterns and factors associated with community opioid dispensing will be examined for different injury types, mechanisms, and population subgroups. Appropriate descriptive statistics will be used to describe the cohort. Regression models will be used to examine factors predictive of levels and duration of opioid use. Nonparametric methods will be applied when the data are not normally distributed. Results: The project is funded by the Royal Brisbane and Women’s Hospital Foundation. As of November 2021, all ethics and data custodian approvals have been granted. Data extraction and linkage has been completed. Data management and analysis is underway with results relating to an analysis for blunt chest trauma patients expected to be published in 2022. Conclusions: Little is currently known of the true prevalence or patterns of opioid dispensing following injury across Queensland. This study will provide new insights about factors associated with high and long-term opioid dispensing at a population level. This information is essential to inform targeted public policy and interventions to reduce the risk of prolonged opioid use and dependence for those injured. The novel work undertaken for this project will be vital to planning, delivering, monitoring, and evaluating health care services for those injured. The findings of this study will be used to inform key stakeholders as well as clinicians and pain management services. International Registered Report Identifier (IRRID): RR1-10.2196/36357 %M 35412468 %R 10.2196/36357 %U https://www.researchprotocols.org/2022/4/e36357 %U https://doi.org/10.2196/36357 %U http://www.ncbi.nlm.nih.gov/pubmed/35412468 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e33680 %T The Impact and Applications of Social Media Platforms for Public Health Responses Before and During the COVID-19 Pandemic: Systematic Literature Review %A Gunasekeran,Dinesh Visva %A Chew,Alton %A Chandrasekar,Eeshwar K %A Rajendram,Priyanka %A Kandarpa,Vasundhara %A Rajendram,Mallika %A Chia,Audrey %A Smith,Helen %A Leong,Choon Kit %+ National University of Singapore, 10 Medical Drive, Singapore, 117597, Singapore, 65 67723737, dineshvg@hotmail.sg %K digital health %K social media %K big data %K population health %K blockchain %K COVID-19 %K review %K benefit %K challenge %K public health %D 2022 %7 11.4.2022 %9 Review %J J Med Internet Res %G English %X Background:  Social media platforms have numerous potential benefits and drawbacks on public health, which have been described in the literature. The COVID-19 pandemic has exposed our limited knowledge regarding the potential health impact of these platforms, which have been detrimental to public health responses in many regions. Objective: This review aims to highlight a brief history of social media in health care and report its potential negative and positive public health impacts, which have been characterized in the literature. Methods:  We searched electronic bibliographic databases including PubMed, including Medline and Institute of Electrical and Electronics Engineers Xplore, from December 10, 2015, to December 10, 2020. We screened the title and abstracts and selected relevant reports for review of full text and reference lists. These were analyzed thematically and consolidated into applications of social media platforms for public health. Results:  The positive and negative impact of social media platforms on public health are catalogued on the basis of recent research in this report. These findings are discussed in the context of improving future public health responses and incorporating other emerging digital technology domains such as artificial intelligence. However, there is a need for more research with pragmatic methodology that evaluates the impact of specific digital interventions to inform future health policy. Conclusions:  Recent research has highlighted the potential negative impact of social media platforms on population health, as well as potentially useful applications for public health communication, monitoring, and predictions. More research is needed to objectively investigate measures to mitigate against its negative impact while harnessing effective applications for the benefit of public health. %M 35129456 %R 10.2196/33680 %U https://www.jmir.org/2022/4/e33680 %U https://doi.org/10.2196/33680 %U http://www.ncbi.nlm.nih.gov/pubmed/35129456 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e33404 %T Mapping Digital Public Health Interventions Among Existing Digital Technologies and Internet-Based Interventions to Maintain and Improve Population Health in Practice: Protocol for a Scoping Review %A Maaß,Laura %A Pan,Chen-Chia %A Freye,Merle %+ Department of Health, Long-Term Care and Pensions, Research Center on Inequality and Social Policy, Mary-Somerville-Straße 3, Bremen, 28359, Germany, 49 421 218 58610, laura.maass@uni-bremen.de %K digital public health %K telemedicine %K electronic health records %K ePrescription %K eReferral %K eConsultation %K eSurveillance %K eVaccination registries %K scoping review %K protocol %D 2022 %7 31.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Rapid developments and implementation of digital technologies in public health domains throughout the last decades have changed the landscape of health delivery and disease prevention globally. A growing number of countries are introducing interventions such as online consultations, electronic health records, or telemedicine to their health systems to improve their populations’ health and improve access to health care. Despite multiple definitions for digital public health and the development of different digital interventions, no study has analyzed whether the utilized technologies fit the definition or the core characteristics of digital public health interventions. A scoping review is therefore needed to explore the extent of the literature on this topic. Objective: The main aim of this scoping review is to outline real-world digital public health interventions on all levels of health care, prevention, and health. The second objective will be the mapping of reported intervention characteristics. These will include nontechnical elements and the technical features of an intervention. Methods: We searched for relevant literature in the following databases: PubMed, Web of Science, CENTRAL (Cochrane Central Register of Controlled Trials), IEEE (Institute of Electrical and Electronics Engineers) Xplore, and the Association for Computing Machinery (ACM) Full-Text Collection. All original study types (observational studies, experimental trials, qualitative studies, and health-economic analyses), as well as governmental reports, books, book chapters, or peer-reviewed full-text conference papers were included when the evaluation and description of a digital health intervention was the primary intervention component. Two authors screened the articles independently in three stages (title, abstract, and full text). Two independent authors will also perform the data charting. We will report our results following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. Results: An additional systematic search in IEEE Xplore and ACM, performed on December 1, 2021, identified another 491 titles. We identified a total of 13,869 papers after deduplication. As of March 2022, the abstract screening state is complete, and we are in the state of screening the 1417 selected full texts for final inclusion. We estimate completing the review in April 2022. Conclusions: To our knowledge, this will be the first scoping review to fill the theoretical definitions of digital public health with concrete interventions and their characteristics. Our scoping review will display the landscape of worldwide existing digital public health interventions that use information and communication technologies. The results of this review will be published in a peer-reviewed journal in early 2022, which can serve as a blueprint for the development of future digital public health interventions. International Registered Report Identifier (IRRID): DERR1-10.2196/33404 %M 35357321 %R 10.2196/33404 %U https://www.researchprotocols.org/2022/3/e33404 %U https://doi.org/10.2196/33404 %U http://www.ncbi.nlm.nih.gov/pubmed/35357321 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e34544 %T The Evaluation of a Social Media Campaign to Increase COVID-19 Testing in Migrant Groups: Cluster Randomized Trial %A Elgersma,Ingeborg Hess %A Fretheim,Atle %A Indseth,Thor %A Munch,Anita Thorolvsen %A Johannessen,Live Bøe %A Hansen,Christine Engh %+ Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Postboks 222, Skøyen, Oslo, 0213, Norway, 47 91584782, ingeborghess.elgersma@fhi.no %K COVID-19 %K SARS-CoV-2 %K social media %K campaign %K cluster randomized trial %K nonpharmaceutical interventions %K migrant %K intervention %K testing %K strategy %K public health %K Facebook %K communication %D 2022 %7 24.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: A low test positivity rate is key to keeping the COVID-19 pandemic under control. Throughout the pandemic, several migrant groups in Norway have seen higher rates of confirmed COVID-19 and related hospitalizations, while test positivity has remained high in the same groups. The Norwegian government has used several platforms for communication, and targeted social media advertisements have in particular been an important part of the communication strategy to reach these groups. Objective: In this study, we aimed to investigate whether such a targeted Facebook campaign increased the rate of COVID-19 tests performed in certain migrant groups. Methods: We randomly assigned 386 Norwegian municipalities and city districts to intervention or control groups. Individuals born in Eritrea, Iraq, Pakistan, Poland, Russia, Somalia, Syria, and Turkey residing in intervention areas were targeted with a social media campaign aiming at increasing the COVID-19 test rate. The campaign message was in a simple language and conveyed in the users’ main language or in English. Results: During the 2-week follow-up period, the predicted probability of having a COVID-19 test taken was 4.82% (95% CI 4.47%-5.18%) in the control group, and 5.58% (95% CI 5.20%-5.99%) in the intervention group (P=.004). Conclusions: Our targeted social media intervention led to a modest increase in test rates among certain migrant groups in Norway. Trial Registration: ClinicalTrials.gov NCT04866589; https://clinicaltrials.gov/ct2/show/NCT04866589 %M 35285811 %R 10.2196/34544 %U https://www.jmir.org/2022/3/e34544 %U https://doi.org/10.2196/34544 %U http://www.ncbi.nlm.nih.gov/pubmed/35285811 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e36060 %T Impact-Oriented Dialogue for Culturally Safe Adolescent Sexual and Reproductive Health in Bauchi State, Nigeria: Protocol for a Codesigned Pragmatic Cluster Randomized Controlled Trial %A Cockcroft,Anne %A Omer,Khalid %A Gidado,Yagana %A Mohammed,Rilwanu %A Belaid,Loubna %A Ansari,Umaira %A Mitchell,Claudia %A Andersson,Neil %+ Community Information for Empowerment and Transparency-Participatory Research at McGill, Department of Family Medicine, McGill University, 5858 Côte-des-Neiges, Suite 300, Montreal, QC, H3S 1Z1, Canada, 1 450 626 8432, anne.cockcroft@mcgill.ca %K adolescents %K sexual and reproductive health %K participatory research %K mixed methods research %K dialogic intervention %K co-design %K cultural safety %K Nigeria %D 2022 %7 15.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adolescents (10-19 years) are a big segment of the Nigerian population, and they face serious risks to their health and well-being. Maternal mortality is very high in Nigeria, and rates of pregnancy and maternal deaths are high among female adolescents. Rates of HIV infection are rising among adolescents, gender violence and sexual abuse are common, and knowledge about sexual and reproductive health risks is low. Adolescent sexual and reproductive health (ASRH) indicators are worse in the north of the country. Objective: In Bauchi State, northern Nigeria, the project will document the nature and extent of ASRH outcomes and risks, discuss the findings and codesign solutions with local stakeholders, and measure the short-term impact of the discussions and proposed solutions. Methods: The participatory research project is a sequential mixed-methods codesign of a pragmatic cluster randomized controlled trial. Focus groups of local stakeholders (female and male adolescents, parents, traditional and religious leaders, service providers, and planners) will identify local priority ASRH concerns. The same stakeholder groups will map their knowledge of factors causing these concerns using the fuzzy cognitive mapping (FCM) technique. Findings from the maps and a scoping review will inform the contextualization of survey instruments to collect information about ASRH from female and male adolescents and parents in households and from local service providers. The survey will take place in 60 Bauchi communities. Adolescents will cocreate materials to share the findings from the maps and survey. In 30 communities, randomly allocated, the project will engage adolescents and other stakeholders in households, communities, and services to discuss the evidence and to design and implement culturally acceptable actions to improve ASRH. A follow-up survey in communities with and without the intervention will measure the short-term impact of these discussions and actions. We will also evaluate the intervention process and use narrative techniques to assess its impact qualitatively. Results: Focus groups to explore ASRH concerns of stakeholders began in October 2021. Baseline data collection in the household survey is expected to take place in mid-2022. The study was approved by the Bauchi State Health Research Ethics Committee, approval number NREC/03/11/19B/2021/03 (March 1, 2021), and by the Faculty of Medicine and Health Sciences Institutional Review Board McGill University (September 13, 2021). Conclusions: Evidence about factors related to ASRH outcomes in Nigeria and implementation and testing of a dialogic intervention to improve these outcomes will fill a gap in the literature. The project will document and test the effectiveness of a participatory approach to ASRH intervention research. Trial Registration: ISRCTN Registry ISRCTN18295275; https://www.isrctn.com/ISRCTN18295275 International Registered Report Identifier (IRRID): DERR1-10.2196/36060 %M 35289762 %R 10.2196/36060 %U https://www.researchprotocols.org/2022/3/e36060 %U https://doi.org/10.2196/36060 %U http://www.ncbi.nlm.nih.gov/pubmed/35289762 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e25614 %T Understanding Public Perceptions of Per- and Polyfluoroalkyl Substances: Infodemiology Study of Social Media %A Tian,Hao %A Gaines,Christy %A Launi,Lori %A Pomales,Ana %A Vazquez,Germaine %A Goharian,Amanda %A Goodnight,Bradley %A Haney,Erica %A Reh,Christopher M %A Rogers,Rachel D %+ Office of Director, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS S106-7, Atlanta, GA, 30341, United States, 1 404 718 5708, ejq7@cdc.gov %K PFAS %K per- and polyfluoroalkyl substances %K social media %K public perceptions %D 2022 %7 11.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Per- and polyfluoroalkyl substances (PFAS) are environmental contaminants that have received significant public attention. PFAS are a large group of human-made chemicals that have been used in industry and consumer products worldwide since the 1950s. Human exposure to PFAS is a growing public health concern. Studies suggest that exposure to PFAS may increase the risk of some cancers and have negative health impacts on the endocrine, metabolic, and immune systems. Federal and state health partners are investigating the exposure to and possible health effects associated with PFAS. Government agencies can observe social media discourse on PFAS to better understand public concerns and develop targeted communication and outreach efforts. Objective: The primary objective of this study is to understand how social media is used to share, disseminate, and engage in public discussions of PFAS-related information in the United States. Methods: We investigated PFAS-related content across 2 social media platforms between May 1, 2017, and April 30, 2019, to identify how social media is used in the United States to seek and disseminate PFAS-related information. Our key variable of interest was posts that mentioned “PFAS,” “PFOA,” “PFOS,” and their hashtag variations across social media platforms. Additional variables included post type, time, PFAS event, and geographic location. We examined term use and post type differences across platforms. We used descriptive statistics and regression analysis to assess the incidence of PFAS discussions and to identify the date, event, and geographic patterns. We qualitatively analyzed social media content to determine the most prevalent themes discussed on social media platforms. Results: Our analysis revealed that Twitter had a significantly greater volume of PFAS-related posts compared with Reddit (98,264 vs 3126 posts). PFAS-related social media posts increased by 670% over 2 years, indicating a marked increase in social media users’ interest in and awareness of PFAS. Active engagement varied across platforms, with Reddit posts demonstrating more in-depth discussions compared with passive likes and reposts among Twitter users. Spikes in PFAS discussions were evident and connected to the discovery of contamination events, media coverage, and scientific publications. Thematic analysis revealed that social media users see PFAS as a significant public health concern and seek a trusted source of information about PFAS-related public health efforts. Conclusions: The analysis identified a prevalent theme—on social media, PFAS are perceived as an immediate public health concern, which demonstrates a growing sense of urgency to understand this emerging contaminant and its potential health impacts. Government agencies can continue using social media research to better understand the changing community sentiment on PFAS and disseminate targeted information and then use social media as a forum for dispelling misinformation, communicating scientific findings, and providing resources for relevant public health services. %M 35275066 %R 10.2196/25614 %U https://www.jmir.org/2022/3/e25614 %U https://doi.org/10.2196/25614 %U http://www.ncbi.nlm.nih.gov/pubmed/35275066 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e34275 %T Creating Effective, Evidence-Based Video Communication of Public Health Science (COVCOM Study): Protocol for a Sequential Mixed Methods Effect Study %A Røislien,Jo %A O'Hara,Jane K %A Smeets,Ionica %A Brønnick,Kolbjørn %A Berg,Siv Hilde %A Shortt,Marie Therese %A Lungu,Daniel Adrian %A Thune,Henriette %A Wiig,Siri %+ SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholms gate 41, Stavanger, 4021, Norway, 47 51 83 10 00, jo.roislien@uis.no %K pandemics %K risk %K public health %K science communication %K mixed methods %K evidence-based medicine %K COVID-19 %D 2022 %7 11.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The nonlinear nature of contagious diseases and the potential for exponential growth can be difficult to grasp for the general public. This has strong implications for public health communication, which needs to be both easily accessible and efficient. A pandemic is an extreme situation, and the accompanying strict societal measures are generally easier to accept if one understands the underlying reasoning behind them. Bringing about informed attitude change and achieving compliance to strict restrictions requires explanations of scientific concepts and terminologies that laypersons can understand. Objective: The aim of the project is to develop effective, evidence-based modes of video communication for translating complex, but important, health messages about pandemics to both the general population and decision makers. The study uses COVID-19 as a case to learn and prepare society for handling the ongoing and future pandemics, as well as to provide evidence-based tools for the science communication toolbox. Methods: The project applies a mixed methods design, combining qualitative methods (eg, interviews, observational studies, literature reviews) and quantitative methods (eg, randomized controlled trials [RCTs]). The project brings together researchers from a wide range of academic fields, as well as communication industry professionals. Results: This study has received funding from the Trond Mohn Foundation through the Research Council of Norway’s “COVID-19 Emergency Call for Proposals” March 2020. Recruitment and data collection for the exploratory first phase of the project ran from February 2021 to March 2021. Creative communication work started in May 2021, and the production of videos for use in the RCTs in the final phase of the project started in September 2021. Conclusions: The COVCOM project will take on several grand challenges within the field of communicating science and provide evidence-based tools to the science communication toolbox. A long-term goal of the project is to contribute to the creation of a more resilient health care system by developing communication responses tailormade for different audiences, preparing society for any future pandemic. International Registered Report Identifier (IRRID): DERR1-10.2196/34275 %M 35147500 %R 10.2196/34275 %U https://www.researchprotocols.org/2022/3/e34275 %U https://doi.org/10.2196/34275 %U http://www.ncbi.nlm.nih.gov/pubmed/35147500 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e32364 %T United States Influenza Search Patterns Since the Emergence of COVID-19: Infodemiology Study %A Cai,Owen %A Sousa-Pinto,Bernardo %+ Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Rua Plácido Costa s/n, Porto, 4200-450, Portugal, 351 225513622, bernardosousapinto@protonmail.com %K COVID-19 %K influenza %K surveillance %K media coverage %K Google Trends %K infodemiology %K monitoring %K trend %K United States %K information-seeking %K online health information %D 2022 %7 3.3.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The emergence and media coverage of COVID-19 may have affected influenza search patterns, possibly affecting influenza surveillance results using Google Trends. Objective: We aimed to investigate if the emergence of COVID-19 was associated with modifications in influenza search patterns in the United States. Methods: We retrieved US Google Trends data (relative number of searches for specified terms) for the topics influenza, Coronavirus disease 2019, and symptoms shared between influenza and COVID-19. We calculated the correlations between influenza and COVID-19 search data for a 1-year period after the first COVID-19 diagnosis in the United States (January 21, 2020 to January 20, 2021). We constructed a seasonal autoregressive integrated moving average model and compared predicted search volumes, using the 4 previous years, with Google Trends relative search volume data. We built a similar model for shared symptoms data. We also assessed correlations for the past 5 years between Google Trends influenza data, US Centers for Diseases Control and Prevention influenza-like illness data, and influenza media coverage data. Results: We observed a nonsignificant weak correlation (ρ= –0.171; P=0.23) between COVID-19 and influenza Google Trends data. Influenza search volumes for 2020-2021 distinctly deviated from values predicted by seasonal autoregressive integrated moving average models—for 6 weeks within the first 13 weeks after the first COVID-19 infection was confirmed in the United States, the observed volume of searches was higher than the upper bound of 95% confidence intervals for predicted values. Similar results were observed for shared symptoms with influenza and COVID-19 data. The correlation between Google Trends influenza data and CDC influenza-like-illness data decreased after the emergence of COVID-19 (2020-2021: ρ=0.643; 2019-2020: ρ=0.902), while the correlation between Google Trends influenza data and influenza media coverage volume remained stable (2020-2021: ρ=0.746; 2019-2020: ρ=0.707). Conclusions: Relevant differences were observed between predicted and observed influenza Google Trends data the year after the onset of the COVID-19 pandemic in the United States. Such differences are possibly due to media coverage, suggesting limitations to the use of Google Trends as a flu surveillance tool. %M 34878996 %R 10.2196/32364 %U https://publichealth.jmir.org/2022/3/e32364 %U https://doi.org/10.2196/32364 %U http://www.ncbi.nlm.nih.gov/pubmed/34878996 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e31813 %T Identifying the Socioeconomic, Demographic, and Political Determinants of Social Mobility and Their Effects on COVID-19 Cases and Deaths: Evidence From US Counties %A Jalali,Niloofar %A Tran,N Ken %A Sen,Anindya %A Morita,Plinio Pelegrini %+ School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 5198884567 ext 31372, plinio.morita@uwaterloo.ca %K COVID-19 %K cases %K deaths %K mobility %K Google mobility data %K clustering %D 2022 %7 3.3.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The spread of COVID-19 at the local level is significantly impacted by population mobility. The U.S. has had extremely high per capita COVID-19 case and death rates. Efficient nonpharmaceutical interventions to control the spread of COVID-19 depend on our understanding of the determinants of public mobility. Objective: This study used publicly available Google data and machine learning to investigate population mobility across a sample of US counties. Statistical analysis was used to examine the socioeconomic, demographic, and political determinants of mobility and the corresponding patterns of per capita COVID-19 case and death rates. Methods: Daily Google population mobility data for 1085 US counties from March 1 to December 31, 2020, were clustered based on differences in mobility patterns using K-means clustering methods. Social mobility indicators (retail, grocery and pharmacy, workplace, and residence) were compared across clusters. Statistical differences in socioeconomic, demographic, and political variables between clusters were explored to identify determinants of mobility. Clusters were matched with daily per capita COVID-19 cases and deaths. Results: Our results grouped US counties into 4 Google mobility clusters. Clusters with more population mobility had a higher percentage of the population aged 65 years and over, a greater population share of Whites with less than high school and college education, a larger percentage of the population with less than a college education, a lower percentage of the population using public transit to work, and a smaller share of voters who voted for Clinton during the 2016 presidential election. Furthermore, clusters with greater population mobility experienced a sharp increase in per capita COVID-19 case and death rates from November to December 2020. Conclusions: Republican-leaning counties that are characterized by certain demographic characteristics had higher increases in social mobility and ultimately experienced a more significant incidence of COVID-19 during the latter part of 2020. %M 35287305 %R 10.2196/31813 %U https://infodemiology.jmir.org/2022/1/e31813 %U https://doi.org/10.2196/31813 %U http://www.ncbi.nlm.nih.gov/pubmed/35287305 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e32213 %T Tracking Demographic Movements and Immunization Status to Improve Children’s Access to Immunization: Field-Based Randomized Controlled Trial %A Ateudjieu,Jérôme %A Tchio-Nighie,Ketina Hirma %A Goura,André Pascal %A Ndinakie,Martin Yakum %A Dieffi Tchifou,Miltiade %A Amada,Lapia %A Tsafack,Marcelin %A Kiadjieu Dieumo,Frank Forex %A Guenou,Etienne %A Nangue,Charlette %A Kenfack,Bruno %+ Department of Health Research, Meilleur Accès Aux Soins de Santé (M.A.SANTE), Avenue De Mvolye (Street 7.331) Biyem-assi Lac – Buildings 1416 and 1410, Yaounde, P.O. Box: 33490, Cameroon, 237 222 311 647, ktchio@masante-cam.org %K immunization status %K coverage %K completeness %K timeliness %K EPI vaccines %K children under five %K Foumban %K Cameroon %K mobile phone %D 2022 %7 1.3.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Countries’ Expanded Program on Immunization (EPI) contribute to the reduction of mortality and morbidity, but access to these vaccines remains limited in most low-income countries. Objective: We aim to assess whether involving community volunteers (CVs) to track children’s vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions can improve children’s vaccination timeliness, completeness, and coverage. Methods: This was a field-based randomized controlled trial and communities of the Foumban health district in West Cameroon were allocated to intervention or control groups. In the intervention group, a CV per community was trained to visit households monthly for a year to assess and record in a register, details of EPI-targeted children, their demographic movements and immunization status. The scanned recorded pages were sent to the health center immunization team through WhatsApp and used to organize monthly community catch-up immunization sessions. In the control group, EPI vaccination sessions were routinely conducted. Surveys were conducted at 6 and 12 months from the beginning of the intervention in both study groups to assess and compare immunization timeliness, coverage, and completeness. Results: Overall, 30 buildings per cluster were surveyed at midline and endline. Of the 633 and 729 visited households in the intervention group at midline and endline, 630 (99.5%) and 718 (98.4%), respectively, consented to participate. In the control group, 507 and 651 households were visited and 505 (99.6%) and 636 (97.7%), respectively, consented to participate. At 12 months intervention, the month one timeliness of bacille Calmette–Guerin (BCG) vaccine did not increase in the intervention group compared with the control group for the age groups 0-11 months (adjusted odds ratio [aOR] 1.1, 95% CI 0.7-1.8) and 0-59 months (aOR 1.1, 95% CI 0.9-1.4), and significantly increased for the first-year BCG vaccine administration for the age group 0-23 months (aOR 1.5, 95% CI 1.1-2.2). The coverage of diphtheria-pertussis-tetanus and hepatitis B+Hemophilus influenzae type B (DPT-Hi +Hb) dose 3 (aOR 2.0, 95% CI 1.5-2.7) and of DPT-Hi+Hb dose 1 (aOR 1.8, 95% CI 1.4-2.4) vaccines increased significantly in the intervention group compared with the control group in the age groups 12-59 months and 12-23 months, respectively. Specific (DPT-Hi+Hb dose 1 to DPT-Hi+Hb dose 3: aOR 1.9, 95% CI 1.4-2.6) and general (BCG to measles: aOR 1.5, 95% CI 1.1-2.1) vaccine completeness increased significantly in the intervention group compared with the control group. Conclusions: Findings support that involving CVs to track children’s vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions improve children’s vaccination timeliness, completeness, and coverage. This strategy should be adopted to improve access to vaccination for EPI target populations and the consistency verified in other contexts. Trial Registration: Pan African Clinical Trials Registry PACTR201808527428720; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3548 %M 35230249 %R 10.2196/32213 %U https://publichealth.jmir.org/2022/3/e32213 %U https://doi.org/10.2196/32213 %U http://www.ncbi.nlm.nih.gov/pubmed/35230249 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e27534 %T Interactive Visualization Applications in Population Health and Health Services Research: Systematic Scoping Review %A Chishtie,Jawad %A Bielska,Iwona Anna %A Barrera,Aldo %A Marchand,Jean-Sebastien %A Imran,Muhammad %A Tirmizi,Syed Farhan Ali %A Turcotte,Luke A %A Munce,Sarah %A Shepherd,John %A Senthinathan,Arrani %A Cepoiu-Martin,Monica %A Irvine,Michael %A Babineau,Jessica %A Abudiab,Sally %A Bjelica,Marko %A Collins,Christopher %A Craven,B Catharine %A Guilcher,Sara %A Jeji,Tara %A Naraei,Parisa %A Jaglal,Susan %+ Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada, 1 6479756965, jac161@gmail.com %K interactive visualization %K data visualization %K secondary health care data %K public health informatics %K population health %K health services research %D 2022 %7 18.2.2022 %9 Review %J J Med Internet Res %G English %X Background: Simple visualizations in health research data, such as scatter plots, heat maps, and bar charts, typically present relationships between 2 variables. Interactive visualization methods allow for multiple related facets such as numerous risk factors to be studied simultaneously, leading to data insights through exploring trends and patterns from complex big health care data. The technique presents a powerful tool that can be used in combination with statistical analysis for knowledge discovery, hypothesis generation and testing, and decision support. Objective: The primary objective of this scoping review is to describe and summarize the evidence of interactive visualization applications, methods, and tools being used in population health and health services research (HSR) and their subdomains in the last 15 years, from January 1, 2005, to March 30, 2019. Our secondary objective is to describe the use cases, metrics, frameworks used, settings, target audience, goals, and co-design of applications. Methods: We adapted standard scoping review guidelines with a peer-reviewed search strategy: 2 independent researchers at each stage of screening and abstraction, with a third independent researcher to arbitrate conflicts and validate findings. A comprehensive abstraction platform was built to capture the data from diverse bodies of literature, primarily from the computer science and health care sectors. After screening 11,310 articles, we present findings from 56 applications from interrelated areas of population health and HSR, as well as their subdomains such as epidemiologic surveillance, health resource planning, access, and use and costs among diverse clinical and demographic populations. Results: In this companion review to our earlier systematic synthesis of the literature on visual analytics applications, we present findings in 6 major themes of interactive visualization applications developed for 8 major problem categories. We found a wide application of interactive visualization methods, the major ones being epidemiologic surveillance for infectious disease, resource planning, health service monitoring and quality, and studying medication use patterns. The data sources included mostly secondary administrative and electronic medical record data. In addition, at least two-thirds of the applications involved participatory co-design approaches while introducing a distinct category, embedded research, within co-design initiatives. These applications were in response to an identified need for data-driven insights into knowledge generation and decision support. We further discuss the opportunities stemming from the use of interactive visualization methods in studying global health; inequities, including social determinants of health; and other related areas. We also allude to the challenges in the uptake of these methods. Conclusions: Visualization in health has strong historical roots, with an upward trend in the use of these methods in population health and HSR. Such applications are being fast used by academic and health care agencies for knowledge discovery, hypotheses generation, and decision support. International Registered Report Identifier (IRRID): RR2-10.2196/14019 %M 35179499 %R 10.2196/27534 %U https://www.jmir.org/2022/2/e27534 %U https://doi.org/10.2196/27534 %U http://www.ncbi.nlm.nih.gov/pubmed/35179499 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e32988 %T Participatory Methods for Systems Modeling of Youth Mental Health: Implementation Protocol %A Freebairn,Louise %A Occhipinti,Jo-An %A Song,Yun Ju C %A Skinner,Adam %A Lawson,Kenny %A Lee,Grace Yeeun %A Hockey,Samuel J %A Huntley,Samantha %A Hickie,Ian B %+ Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, 94 Mallett Street, Camperdown, 2050, Australia, 61 93510774, louise.freebairn@sydney.edu.au %K participatory system modeling %K youth mental health %K co-design %K public health systems research %K mental health services %D 2022 %7 7.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite significant investment, mental health issues remain a leading cause of death among young people globally. Sophisticated decision analysis methods are needed to better understand the dynamic and multisector drivers of youth mental health. System modeling can help explore complex issues such as youth mental health and inform strategies to effectively respond to local needs and achieve lasting improvements. The advantages of engaging stakeholders in model development processes have long been recognized; however, the methods for doing so are often not well-described. Objective: This paper aims to describe the participatory procedures that will be used to support systems modeling for national multisite implementation. The Right Care, First Time, Where You Live research program will focus on regional youth mental health applications of systems modeling in 8 different sites across Australia. Methods: The participatory model development approach involves an iterative process of engaging with a range of participants, including people with lived experience of mental health issues. Their knowledge of the local systems, pathways, and drivers is combined with the academic literature and data to populate the models and validate their structure. The process centers around 3 workshops where participants interact and actively engage in group model-building activities to define, refine, and validate the systems models. This paper provides a detailed blueprint for the implementation of this process for mental health applications. Results: The participatory modeling methods described in this paper will be implemented at 2 sites per year from 2022 to 2025. The 8 selected sites have been chosen to capture variations in important factors, including determinants of mental health issues and access to services. Site engagement commenced in August 2021, and the first modeling workshops are scheduled to commence in February 2022. Conclusions: Mental health system decision makers require tools to help navigate complex environments and leverage interdisciplinary problem-solving. Systems modeling can mobilize data from diverse sources to explore a range of scenarios, including the impact of interventions in different combinations and contexts. Involving stakeholders in the model development process ensures that the model findings are context-relevant and fit-for-purpose to inform decision-making. International Registered Report Identifier (IRRID): PRR1-10.2196/32988 %M 35129446 %R 10.2196/32988 %U https://www.researchprotocols.org/2022/2/e32988 %U https://doi.org/10.2196/32988 %U http://www.ncbi.nlm.nih.gov/pubmed/35129446 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e25690 %T Assessment of Personal Exposure to Particulate Air Pollution in Different Microenvironments and Traveling by Several Modes of Transportation in Bogotá, Colombia: Protocol for a Mixed Methods Study (ITHACA) %A Malagon-Rojas,Jeadran N %A Pinzón-Silva,Diana Carolina %A Parra,Eliana L %A Lagos M,Luisa F %A Toloza-Perez,Yesith Guillermo %A Hernández Florez,Luis Jorge %A Morales Betancourt,Ricardo %A Romero,Sol Angie %A Ríos Cabra,Ana Paola %A Sarmiento,Olga L %+ Grupo de Salud Ambiental y Laboral, Instituto Nacional de Salud, Ac. 26 #5120, Bogotá, 111311, Colombia, 57 2207700 ext 1476, jmalagon@ins.gov.co %K air pollution %K particulate matter %K black carbon %K mixed methods %K toxic %K air quality %K respiratory %K pollution %K pollutants %K microenvironments %K Bogota %K respiratory disease %K exposure to air pollutants %K air contamination %D 2022 %7 31.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Air pollution in most countries exceeds the levels recommended by the World Health Organization, causing up to one-third of deaths due to noncommunicable diseases. Fine particulate matter (PM2.5) and black carbon (BC) from mobile sources are the main contaminants. Objective: The aim of this study is to assess the relationship of exposure to air pollutants (PM2.5 and BC) in microenvironments according to respiratory health and physical activity in users traveling by different types of transportation in Bogotá, Colombia. Methods: A mixed methods study based on a convergent parallel design will be performed with workers and students. The sample will include 350 healthy transport users traveling by different urban transportation modes in three main routes in Bogotá. The study is broken down into two components: (1) a descriptive qualitative component focused on assessing the individual perception of air pollution using semistructured interviews; and (2) a cross-sectional study measuring the individual exposure to PM2.5 and BC using portable instruments (DustTrak and microAeth, respectively), pulmonary function by spirometry, and physical activity with accelerometry. The analysis will include concurrent triangulation and logistic regression. Results: The findings will be useful for the conception, design, and decision-making process in the sectors of health and mobility from public, academy, and private perspectives. This study includes personal measurements of PM2.5 and BC during typical trips in the city to assess the exposure to these contaminants in the major roadways in real time. The study further compares the performance of two different lung tests to identify possible short-term respiratory effects. As a limitation, the protocol will include participants from different institutions in the city, which are not necessarily representative of all healthy populations in Bogotá. In this sense, it is not possible to draw causation conclusions. Moreover, a convergent parallel design could be especially problematic concerning integration because such a design often lacks a clear plan for making a connection between the two sets of results, which may not be well connected. Nevertheless, this study adopts a procedure for how to integrate qualitative and quantitative data in the interpretation of the results and a multilevel regression. The time that participants must live in the city will be considered; this will be controlled in the stratified analysis. Another limitation is the wide age range and working status of the participants. Regional pollution levels and episodes (PM2.5) will be handled as confounding variables. The study is currently in the enrollment phase of the participants. Measurements have been made on 300 participants. Pandemic conditions affected the study schedule; however, the results are likely to be obtained by late 2022. Conclusions: This study investigates the exposure to air pollutants in microenvironments in Bogotá, Colombia. To our knowledge, this is the first mixed methods study focusing on PM2.5, BC, and respiratory health effects in a city over 2 meters above sea level. This study will provide an integration of air pollution exposure variables and respiratory health effects in different microenvironments. International Registered Report Identifier (IRRID): PRR1-10.2196/25690 %M 35099404 %R 10.2196/25690 %U https://www.researchprotocols.org/2022/1/e25690 %U https://doi.org/10.2196/25690 %U http://www.ncbi.nlm.nih.gov/pubmed/35099404 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e32567 %T Dissemination and Implementation of a Google Apple Exposure Notification System for COVID-19 Risk Mitigation at a National Public University: Protocol for a Pilot Evaluation Study in a Real-World Setting %A Melvin,Cathy Lee %A Sterba,Katherine Regan %A Gimbel,Ron %A Lenert,Leslie Andrew %A Cartmell,Kathleen B %A , %+ Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, 68 President St. Room BE103, Charleston, SC, 29425, United States, 1 843 876 2426, melvinc@musc.edu %K COVID-19 %K risk %K mitigation %K mobile phone technology %K exposure notification system %K university setting %K implementation science %K implementation %K dissemination %K notification %K university %K exposure %K transmission %K communication %K strategy %K outcome %K acceptability %K adoption %K usage %D 2022 %7 19.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: As SARS-CoV-2, the virus that causes COVID-19, spread rapidly across the United States in the spring of 2020, institutions of higher education faced numerous challenges associated with minimizing risk of exposure to COVID-19 among their students, faculty, staff, and surrounding communities. This paper describes the protocol, South Carolina (SC) Safer Together, developed by Clemson University (Clemson) to design, deploy, and evaluate multi-level communication and dissemination and implementation (D&I) strategies in line with recommendations from governmental and educational agencies to mitigate the risk of exposure to COVID-19. Safer Together was enhanced by the addition of the Google/Apple Exposure Notification app, an alternative strategy to support a recommendation of COVID-19 testing outcomes: contact tracing, isolation, and quarantine. Objective: This study aimed to (1) describe the content and intended audiences of D&I strategies used to deploy recommended COVID-19 mitigation strategies on a major college campus; (2) determine the reach, acceptability, adoption, and use of D&I strategies among target audiences among university students, faculty, and staff; and (3) characterize barriers and facilitators to the implementation and use of recommended mitigation strategies. Methods: The study team incorporated elements of the Health Belief Model, the Technology Acceptance Model, communication and social marketing models, and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to identify and develop appropriate constructs and specific outcomes for inclusion in our approach to evaluate the communication, dissemination and implementation processes related to deployment of Safer Together at Clemson. A parallel convergent mixed methods design was used to (1) inform implementation strategies used to launch the program and (2) evaluate program reach, acceptability, adoption, and use guided by the RE-AIM framework. Data collection tools include surveys, data analytics–tracking, and focus groups or interviews with key stakeholders (students, employees, and university leadership). Results: Rigorously studying both the dissemination and implementation of Safer Together in a national public university setting is expected to yield lessons that will be valuable at many organizational and governmental settings. On a local level, broad adoption and use of the Safer Together may help reduce COVID-19 transmission and keep the university “open.” On a larger scale, lessons learned on how to influence student and employee behavior with respect to the use of a public health outbreak prevention tool including Safer Together may be applicable in future pandemic and outbreak situations. Conclusions: This study proposes a structured, theory-driven approach to evaluate dissemination and implementation strategies associated with the deployment of Safer Together in a university setting from the viewpoint of students, employees, and university leadership. Our results will inform future implementation of apps such as Safer Together at major state universities in SC. International Registered Report Identifier (IRRID): DERR1-10.2196/32567 %M 34978533 %R 10.2196/32567 %U https://www.researchprotocols.org/2022/1/e32567 %U https://doi.org/10.2196/32567 %U http://www.ncbi.nlm.nih.gov/pubmed/34978533 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e25589 %T Perceived Impact of Outdoor Swimming on Health: Web-Based Survey %A Massey,Heather %A Gorczynski,Paul %A Harper,C Mark %A Sansom,Lisa %A McEwan,Kieren %A Yankouskaya,Alla %A Denton,Hannah %+ Extreme Environments Laboratory, School of Sport, Health and Exercise Science, University of Portsmouth, Spinnaker building, Cambridge road, Portsmouth, PO1 2ER, United Kingdom, 44 02392843545, heather.massey@port.ac.uk %K open water swimming %K blue space %K blue gym %K mental health %K physical health %D 2022 %7 4.1.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: Outdoor swimming in lakes, lidos (outdoor pools), rivers, and the sea has grown in popularity in many countries, including the United Kingdom. Many anecdotal accounts indicate improvements in medical conditions, which are considered a consequence of outdoor swimming. Objective: The aim of this study is to better understand outdoor swimmers’ perceptions of their health and the extent to which participation impacted their existing self-reported symptoms. Methods: A survey was conducted to investigate outdoor swimming behaviors and reports of any diagnosed medical conditions. Medical conditions were coded into categories, and descriptive statistics were generated regarding the outdoor swimmers’ behaviors and the effect that outdoor swimming had on their medical symptoms if any. The medical categories were clustered into five larger categories based on their prevalence in the current sample: mental health; musculoskeletal and injury; neurological; cardiovascular and blood disease; and other, which comprises inflammatory, immune, endocrine, and respiratory conditions. Results: In total, 722 outdoor swimmers responded, of whom 498 (68.9%) were female. The probability of outdoor swimming having some positive impact on health across all medical categories was 3.57 times higher compared with no impact (B=1.28, 95% CI 0.63-1.91; P<.001), 44.32 times higher for the mental health category (B=3.79, 95% CI 2.28-5.30; P<.001), 5.25 times higher for musculoskeletal and injury category (B=1.66, 95% CI 0.52-2.79; P=.004), and 4.02 times higher for the other category (B=1.39, 95% CI 0.27-2.51; P=.02). Overall, outdoor swimming was associated with perceived reductions in symptoms of poor mental health (χ22=25.1; P<.001), musculoskeletal and injury (χ22=8.2; P=.04), cardiovascular and blood (χ22=14.7; P=.006), and other conditions (χ22=18.2; P<.001). Conclusions: Physical activity in the form of outdoor swimming is perceived to have positive impacts on health and is associated with perceived symptom reductions in mental health, musculoskeletal and injury, and cardiovascular and blood conditions. This study cannot provide causal relationships or provide mechanistic insights. However, it does provide a starting point for more targeted prospective intervention research into individual conditions or categories of conditions to establish the impact in those who choose to start outdoor swimming. %M 34982711 %R 10.2196/25589 %U https://www.i-jmr.org/2022/1/e25589 %U https://doi.org/10.2196/25589 %U http://www.ncbi.nlm.nih.gov/pubmed/34982711 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e19183 %T User Behaviors and User-Generated Content in Chinese Online Health Communities: Comparative Study %A Lei,Yuqi %A Xu,Songhua %A Zhou,Linyun %+ Institute of Medical Artificial Intelligence, The Second Affiliated Hospital of Xi’an Jiaotong University, No 5 Jianqiang Road, Xincheng District, Xi’an, 710016, China, 86 029 82666758, 36832164@qq.com %K online health community %K user behaviors %K user-generated content %K social network analysis %K weighted knowledge network %D 2021 %7 15.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Online health communities (OHCs) have increasingly gained traction with patients, caregivers, and supporters globally. Chinese OHCs are no exception. However, user-generated content (UGC) and the associated user behaviors in Chinese OHCs are largely underexplored and rarely analyzed systematically, forfeiting valuable opportunities for optimizing treatment design and care delivery with insights gained from OHCs. Objective: This study aimed to reveal both the shared and distinct characteristics of 2 popular OHCs in China by systematically and comprehensively analyzing their UGC and the associated user behaviors. Methods: We concentrated on studying the lung cancer forum (LCF) and breast cancer forum (BCF) on Mijian, and the diabetes consultation forum (DCF) on Sweet Home, because of the importance of the 3 diseases among Chinese patients and their prevalence on Chinese OHCs in general. Our analysis explored the key user activities, small-world effect, and scale-free characteristics of each social network. We examined the UGC of these forums comprehensively and adopted the weighted knowledge network technique to discover salient topics and latent relations among these topics on each forum. Finally, we discussed the public health implications of our analysis findings. Results: Our analysis showed that the number of reads per thread on each forum followed gamma distribution (HL=0, HB=0, and HD=0); the number of replies on each forum followed exponential distribution (adjusted RL2=0.946, adjusted RB2=0.958, and adjusted RD2=0.971); and the number of threads a user is involved with (adjusted RL2=0.978, adjusted RB2=0.964, and adjusted RD2=0.970), the number of followers of a user (adjusted RL2=0.989, adjusted RB2=0.962, and adjusted RD2=0.990), and a user’s degrees (adjusted RL2=0.997, adjusted RB2=0.994, and adjusted RD2=0.968) all followed power-law distribution. The study further revealed that users are generally more active during weekdays, as commonly witnessed in all 3 forums. In particular, the LCF and DCF exhibited high temporal similarity (ρ=0.927; P<.001) in terms of the relative thread posting frequencies during each hour of the day. Besides, the study showed that all 3 forums exhibited the small-world effect (mean σL=517.15, mean σB=275.23, and mean σD=525.18) and scale-free characteristics, while the global clustering coefficients were lower than those of counterpart international OHCs. The study also discovered several hot topics commonly shared among the 3 disease forums, such as disease treatment, disease examination, and diagnosis. In particular, the study found that after the outbreak of COVID-19, users on the LCF and BCF were much more likely to bring up COVID-19–related issues while discussing their medical issues. Conclusions: UGC and related online user behaviors in Chinese OHCs can be leveraged as important sources of information to gain insights regarding individual and population health conditions. Effective and timely mining and utilization of such content can continuously provide valuable firsthand clues for enhancing the situational awareness of health providers and policymakers. %M 34914615 %R 10.2196/19183 %U https://www.jmir.org/2021/12/e19183 %U https://doi.org/10.2196/19183 %U http://www.ncbi.nlm.nih.gov/pubmed/34914615 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e31734 %T Long-term Effectiveness of a Multistrategy Behavioral Intervention to Increase the Nutritional Quality of Primary School Students’ Online Lunch Orders: 18-Month Follow-up of the Click & Crunch Cluster Randomized Controlled Trial %A Wyse,Rebecca %A Delaney,Tessa %A Stacey,Fiona %A Lecathelinais,Christophe %A Ball,Kylie %A Zoetemeyer,Rachel %A Lamont,Hannah %A Sutherland,Rachel %A Nathan,Nicole %A Wiggers,John H %A Wolfenden,Luke %+ Hunter New England Population Health, Locked Bag 10, Wallsend, 2287, Australia, 61 2 404 20272, r.wyse@newcastle.edu.au %K child diet %K consumer behavior %K intervention %K RCT %K public health nutrition %K obesity %K school %K school canteen %K long-term follow-up %K choice architecture %K public health %K nutrition %K children %K diet %K eHealth %K school lunch %D 2021 %7 29.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: School food services, including cafeterias and canteens, are an ideal setting in which to improve child nutrition. Online canteen ordering systems are increasingly common and provide unique opportunities to deliver choice architecture strategies to nudge users to select healthier items. Despite evidence of short-term effectiveness, there is little evidence regarding the long-term effectiveness of choice architecture interventions, particularly those delivered online. Objective: This study determined the long-term effectiveness of a multistrategy behavioral intervention (Click & Crunch) embedded within an existing online school lunch-ordering system on the energy, saturated fat, sugar, and sodium content of primary school students’ lunch orders 18 months after baseline. Methods: This cluster randomized controlled trial (RCT) involved a cohort of 2207 students (aged 5-12 years) from 17 schools in New South Wales, Australia. Schools were randomized to receive either a multistrategy behavioral intervention or the control (usual online ordering only). The intervention strategies ran continuously for 14-16.5 months until the end of follow-up data collection. Trial primary outcomes (ie, mean total energy, saturated fat, sugar and sodium content of student online lunch orders) and secondary outcomes (ie, the proportion of online lunch order items that were categorized as everyday, occasional, and caution) were assessed over an 8-week period at baseline and 18-month follow-up. Results: In all, 16 schools (94%) participated in the 18-month follow-up. Over time, from baseline to follow-up, relative to control orders, intervention orders had significantly lower energy (–74.1 kJ; 95% CI [–124.7, –23.4]; P=.006) and saturated fat (–0.4 g; 95% CI [–0.7, –0.1]; P=.003) but no significant differences in sugar or sodium content. Relative to control schools, the odds of purchasing everyday items increased significantly (odds ratio [OR] 1.2; 95% CI [1.1, 1.4]; P=.009, corresponding to a +3.8% change) and the odds of purchasing caution items significantly decreased among intervention schools (OR 0.7, 95% CI [0.6, 0.9]; P=.002, corresponding to a –2.6% change). There was no between-group difference over time in canteen revenue. Conclusions: This is the first study to investigate the sustained effect of a choice architecture intervention delivered via an online canteen ordering systems in schools. The findings suggest that there are intervention effects up to 18-months postbaseline in terms of decreased energy and saturated fat content and changes in the relative proportions of healthy and unhealthy food purchased for student lunches. As such, this intervention approach may hold promise as a population health behavior change strategy within schools and may have implications for the use of online food-ordering systems more generally; however, more research is required. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000855224; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375075 %M 34847063 %R 10.2196/31734 %U https://www.jmir.org/2021/11/e31734 %U https://doi.org/10.2196/31734 %U http://www.ncbi.nlm.nih.gov/pubmed/34847063 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e33088 %T Assessing Values and Preferences Toward SARS-CoV-2 Self-testing Among the General Population and Their Representatives, Health Care Personnel, and Decision-Makers: Protocol for a Multicountry Mixed Methods Study %A Shilton,Sonjelle %A Ivanova Reipold,Elena %A Roca Álvarez,Albert %A Martínez-Pérez,Guillermo Z %+ FIND, the global alliance for diagnostics, Chemin des Mines 9, Geneva, 1202, Switzerland, 41 22 710 05 90, sonjelle.shilton@finddx.org %K COVID-19 %K SARS-CoV-2 %K diagnostic %K self-testing %K mixed methods %K testing %K protocol %K preference %K testing %K population %K health care worker %K decision-making %K accessibility %K transmission %K screening %D 2021 %7 26.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Accessible, safe, and client-centered SARS-CoV-2 testing services are an effective way to halt its transmission. Testing enables infected individuals to isolate or quarantine to prevent further transmission. In countries with limited health systems and laboratory capacity, it can be challenging to provide accessible and safe screening for COVID-19. Self-testing provides a convenient, private, and safe testing option; however, it also raises important concerns about lack of counseling and ensuring timely reporting of self-test results to national surveillance systems. Investigating community members’ views and perceptions regarding SARS-CoV-2 self-testing is crucial to inform the most effective and safe strategies for implementing said testing. Objective: We aimed to determine whether SARS-CoV-2 self-testing was useful to diagnose and prevent the spread of SARS-CoV-2 for populations in low-resource settings and under which circumstances it would be acceptable. Methods: This multisite, mixed methods, observational study will be conducted in 9 countries—Brazil, India, Indonesia, Kenya, Malawi, Nigeria, Peru, the Philippines, and South Africa—and will consists of 2 components: cross-sectional surveys and interviews (semistructured and group) among 4 respondent groupings: the general population, general population representatives, health care workers, and decision-makers. General population and health care worker survey responses will be analyzed separately from each other, using bivariate and multivariate inferential analysis and descriptive statistics. Semistructured interviews and group interviews will be audiorecorded, transcribed, and coded for thematic comparative analysis. Results: As of November 19, 2021, participant enrollment is ongoing; 4364 participants have been enrolled in the general population survey, and 2233 participants have been enrolled in the health care workers survey. In the qualitative inquiry, 298 participants have been enrolled. We plan to complete data collection by December 31, 2021 and publish results in 2022 via publications, presentations at conferences, and dissemination events specifically targeted at local decision-makers, civil society, and patient groups. Conclusions: The views and perceptions of local populations are crucial in the discussion of the safest strategies for implementing SARS-CoV-2 self-testing. We intend to identify sociocultural specificities that may hinder or accelerate the widespread utilization of SARS-CoV-2 self-testing. International Registered Report Identifier (IRRID): DERR1-10.2196/33088 %M 34726608 %R 10.2196/33088 %U https://www.researchprotocols.org/2021/11/e33088 %U https://doi.org/10.2196/33088 %U http://www.ncbi.nlm.nih.gov/pubmed/34726608 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e33365 %T Effective Treatment Strategies for the Removal of Antibiotic-Resistant Bacteria, Antibiotic-Resistance Genes, and Antibiotic Residues in the Effluent From Wastewater Treatment Plants Receiving Municipal, Hospital, and Domestic Wastewater: Protocol for a Systematic Review %A Alam,Mahbub-Ul %A Ferdous,Sharika %A Ercumen,Ayse %A Lin,Audrie %A Kamal,Abul %A Luies,Sharmin Khan %A Sharior,Fazle %A Khan,Rizwana %A Rahman,Md Ziaur %A Parvez,Sarker Masud %A Amin,Nuhu %A Tadesse,Birkneh Tilahun %A Moushomi,Niharu Akter %A Hasan,Rezaul %A Taneja,Neelam %A Islam,Mohammad Aminul %A Rahman,Mahbubur %+ Environmental Interventions Unit, Infectious Disease Division, icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh, 880 1818585465, mahbubalam@icddrb.org %K antimicrobial resistance %K antimicrobial-resistant bacteria %K antibiotic-resistant bacteria %K antimicrobial-resistance genes %K antibiotic-resistance genes %K antibiotics %K antibiotic residues %K wastewater treatment plant %K effluent %K systematic review %D 2021 %7 26.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The widespread and unrestricted use of antibiotics has led to the emergence and spread of antibiotic-resistant bacteria (ARB), antibiotic-resistance genes (ARGs), and antibiotic residues in the environment. Conventional wastewater treatment plants (WWTPs) are not designed for effective and adequate removal of ARB, ARGs, and antibiotic residues, and therefore, they play an important role in the dissemination of antimicrobial resistance (AMR) in the natural environment. Objective: We will conduct a systematic review to determine the most effective treatment strategies for the removal of ARB, ARGs, and antibiotic residues from the treated effluent disposed into the environment from WWTPs that receive municipal, hospital, and domestic discharge. Methods: We will search the MEDLINE, EMBASE, Web of Science, World Health Organization Global Index Medicus, and ProQuest Environmental Science Collection databases for full-text peer-reviewed journal articles published between January 2001 and December 2020. We will select only articles published in the English language. We will include studies that measured (1) the presence, concentration, and removal rate of ARB/ARGs going from WWTP influent to effluent, (2) the presence, concentration, and types of antibiotics in the effluent, and (3) the possible selection of ARB in the effluent after undergoing treatment processes in WWTPs. At least two independent reviewers will extract data and perform risk of bias assessment. An acceptable or narrative synthesis method will be followed to synthesize the data and present descriptive characteristics of the included studies in a tabular form. The study has been approved by the Ethics Review Board at the International Centre for Diarrhoeal Disease Research, Bangladesh (protocol number: PR-20113). Results: This protocol outlines our proposed methodology for conducting a systematic review. Our results will provide an update to the existing literature by searching additional databases. Conclusions: Findings from our systematic review will inform the planning of proper treatment methods that can effectively reduce the levels of ARB, ARGs, and residual antibiotics in effluent, thus lowering the risk of the environmental spread of AMR and its further transmission to humans and animals. International Registered Report Identifier (IRRID): PRR1-10.2196/33365 %M 34842550 %R 10.2196/33365 %U https://www.researchprotocols.org/2021/11/e33365 %U https://doi.org/10.2196/33365 %U http://www.ncbi.nlm.nih.gov/pubmed/34842550 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e26660 %T Obesity-Related Communication in Digital Chinese News From Mainland China, Hong Kong, and Taiwan: Automated Content Analysis %A Chang,Angela %A Schulz,Peter Johannes %A Jiao,Wen %A Liu,Matthew Tingchi %+ Faculty of Social Sciences, University of Macau, E21 FSS Bldg, 2nd Fl., Taipa, 100, Macao, 853 88228991, wychang@um.edu.mo %K public health %K computational content %K digital research methods %K obesity discourse %K gene disorders %K noncommunicable disease %D 2021 %7 23.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The fact that the number of individuals with obesity has increased worldwide calls into question media efforts for informing the public. This study attempts to determine the ways in which the mainstream digital news covers the etiology of obesity and diseases associated with the burden of obesity. Objective: The dual objectives of this study are to obtain an understanding of what the news reports on obesity and to explore meaning in data by extending the preconceived grounded theory. Methods: The 10 years of news text from 2010 to 2019 compared the development of obesity-related coverage and its potential impact on its perception in Mainland China, Hong Kong, and Taiwan. Digital news stories on obesity along with affliction and inferences in 9 Chinese mainstream newspapers were sampled. An automatic content analysis tool, DiVoMiner was proposed. This computer-aided platform is designed to organize and filter large sets of data on the basis of the patterns of word occurrence and term discovery. Another programming language, Python 3, was used to explore connections and patterns created by the aggregated interactions. Results: A total of 30,968 news stories were identified with increasing attention since 2016. The highest intensity of newspaper coverage of obesity communication was observed in Taiwan. Overall, a stronger focus on 2 shared causative attributes of obesity is on stress (n=4483, 33.0%) and tobacco use (n=3148, 23.2%). The burdens of obesity and cardiovascular diseases are implied to be the most, despite the aggregated interaction of edge centrality showing the highest link between the “cancer” and obesity. This study goes beyond traditional journalism studies by extending the framework of computational and customizable web-based text analysis. This could set a norm for researchers and practitioners who work on data projects largely for an innovative attempt. Conclusions: Similar to previous studies, the discourse between the obesity epidemic and personal afflictions is the most emphasized approach. Our study also indicates that the inclination of blaming personal attributes for health afflictions potentially limits social and governmental responsibility for addressing this issue. %M 34817383 %R 10.2196/26660 %U https://publichealth.jmir.org/2021/11/e26660 %U https://doi.org/10.2196/26660 %U http://www.ncbi.nlm.nih.gov/pubmed/34817383 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 6 %N 4 %P e28920 %T Understanding “Atmosome”, the Personal Atmospheric Exposome: Comprehensive Approach %A Bhimaraju,Hari %A Nag,Nitish %A Pandey,Vaibhav %A Jain,Ramesh %+ Donald Bren School of Information and Computer Sciences, University of California, Donald Bren Hall, 6210, Irvine, CA, 92697, United States, 1 949 824 7427, hari.bhimaraju@columbia.edu %K exposome %K exposomics %K personal health %K indoor air quality %K health state estimation %K health informatics %K public health policy %K epidemiology %K embedded systems %K internet of things %D 2021 %7 23.11.2021 %9 Original Paper %J JMIR Biomed Eng %G English %X Background: Modern environmental health research extensively focuses on outdoor air pollutants and their effects on public health. However, research on monitoring and enhancing individual indoor air quality is lacking. The field of exposomics encompasses the totality of human environmental exposures and its effects on health. A subset of this exposome deals with atmospheric exposure, termed the “atmosome.” The atmosome plays a pivotal role in health and has significant effects on DNA, metabolism, skin integrity, and lung health. Objective: The aim of this work is to develop a low-cost, comprehensive measurement system for collecting and analyzing atmosomic factors. The research explores the significance of the atmosome in personalized and preventive care for public health. Methods: An internet of things microcontroller-based system is introduced and demonstrated. The system collects real-time indoor air quality data and posts it to the cloud for immediate access. Results: The experimental results yield air quality measurements with an accuracy of 90% when compared with precalibrated commercial devices and demonstrate a direct correlation between lifestyle and air quality. Conclusions: Quantifying the individual atmosome is a monumental step in advancing personalized health, medical research, and epidemiological research. The 2 main goals in this work are to present the atmosome as a measurable concept and to demonstrate how to implement it using low-cost electronics. By enabling atmosome measurements at a communal scale, this work also opens up potential new directions for public health research. Researchers will now have the data to model the impact of indoor air pollutants on the health of individuals, communities, and specific demographics, leading to novel approaches for predicting and preventing diseases. %M 38907376 %R 10.2196/28920 %U https://biomedeng.jmir.org/2021/4/e28920 %U https://doi.org/10.2196/28920 %U http://www.ncbi.nlm.nih.gov/pubmed/38907376 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e21142 %T Recruiting Participants for Population Health Intervention Research: Effectiveness and Costs of Recruitment Methods for a Cohort Study %A Wasfi,Rania %A Poirier Stephens,Zoe %A Sones,Meridith %A Laberee,Karen %A Pugh,Caitlin %A Fuller,Daniel %A Winters,Meghan %A Kestens,Yan %+ Centre for Surveillance and Applied Research, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1A 0K9, Canada, 1 3435537356, rania.wasfi@phac-aspc.gc.ca %K recruitment methods %K Facebook recruitment %K cost-effectiveness %K built environment %K intervention research %K natural experiment %K mobile phone %D 2021 %7 12.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Public health research studies often rely on population-based participation and draw on various recruitment methods to establish samples. Increasingly, researchers are turning to web-based recruitment tools. However, few studies detail traditional and web-based recruitment efforts in terms of costs and potential biases. Objective: This study aims to report on and evaluate the cost-effectiveness, time effectiveness, and sociodemographic representation of diverse recruitment methods used to enroll participants in 3 cities of the Interventions, Research, and Action in Cities Team (INTERACT) study, a cohort study conducted in Canadian cities. Methods: Over 2017 and 2018 in Vancouver, Saskatoon, and Montreal, the INTERACT study used the following recruitment methods: mailed letters, social media (including sponsored Facebook advertisements), news media, partner communications, snowball recruitment, in-person recruitment, and posters. Participation in the study involved answering web-based questionnaires (at minimum), activating a smartphone app to share sensor data, and wearing a device for mobility and physical activity monitoring. We describe sociodemographic characteristics by the recruitment method and analyze performance indicators, including cost, completion rate, and time effectiveness. Effectiveness included calculating cost per completer (ie, a participant who completed at least one questionnaire), the completion rate of a health questionnaire, and the delay between completion of eligibility and health questionnaires. Cost included producing materials (ie, printing costs), transmitting recruitment messages (ie, mailing list rental, postage, and sponsored Facebook posts charges), and staff time. In Montreal, the largest INTERACT sample, we modeled the number of daily recruits through generalized linear models accounting for the distributed lagged effects of recruitment campaigns. Results: Overall, 1791 participants were recruited from 3 cities and completed at least one questionnaire: 318 in Vancouver, 315 in Saskatoon, and 1158 in Montreal. In all cities, most participants chose to participate fully (questionnaires, apps, and devices). The costs associated with a completed participant varied across recruitment methods and by city. Facebook advertisements generated the most recruits (n=687), at a cost of CAD $15.04 (US $11.57; including staff time) per completer. Mailed letters were the costliest, at CAD $108.30 (US $83.3) per completer but served to reach older participants. All methods resulted in a gender imbalance, with women participating more, specifically with social media. Partner newsletters resulted in the participation of younger adults and were cost-efficient (CAD $5.16 [US $3.97] per completer). A generalized linear model for daily Montreal recruitment identified 2-day lag effects on most recruitment methods, except for the snowball campaign (4 days), letters (15 days), and reminder cards (5 days). Conclusions: This study presents comprehensive data on the costs, effectiveness, and bias of population recruitment in a cohort study in 3 Canadian cities. More comprehensive documentation and reporting of recruitment efforts across studies are needed to improve our capacity to conduct inclusive intervention research. %M 34587586 %R 10.2196/21142 %U https://www.jmir.org/2021/11/e21142 %U https://doi.org/10.2196/21142 %U http://www.ncbi.nlm.nih.gov/pubmed/34587586 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e28344 %T COVID-19 Knowledge, Attitudes, and Practices Among People in Bangladesh: Telephone-Based Cross-sectional Survey %A Rabbani,Md Golam %A Akter,Orin %A Hasan,Md Zahid %A Samad,Nandeeta %A Mahmood,Shehrin Shaila %A Joarder,Taufique %+ Public Health Foundation, Bangladesh, 54 Inner Circular Road, Scaut Market, Naya Paltan, Dhaka, 1217, Bangladesh, 880 1732292488, rabbaniduihe@gmail.com %K COVID-19 %K knowledge %K attitude %K practice %K risk communication and community engagement %K social and behavior change communication %K Bangladesh %K COVID-19 %K risk %K pandemic %K risk communication %D 2021 %7 5.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The world has been grappling with the COVID-19 pandemic, a dire public health crisis, since December 2019. Preventive and control measures have been adopted to reduce the spread of COVID-19. To date, the public’s knowledge, attitudes, and practices regarding COVID-19 across Bangladesh have been poorly understood. Therefore, it is important to assess people’s knowledge, attitudes, and practices (KAP) toward the disease and suggest appropriate strategies to combat COVID-19 effectively. Objective: This study aimed to assess the KAP of Bangladeshi people toward COVID-19 and to identify their determinants. Methods: We conducted a country-wide cross-sectional telephonic survey from May 7 to 29, 2020. A purposive sampling method was applied, and adult Bangladeshi citizens who have mobile phones were approached to participate in the survey. Interviews were conducted based on verbal consent. Multiple logistic regression analyses and several tests were performed to identify the factors associated with KAP related to COVID-19. Results: A total of 492 of 576 Bangladeshi adults aged 18 years and above completed the interview, with a response rate of 85.4% (492/576). Of the 492 participants, 321 (65.2%) were male, and 304 (61.8%) lived in a rural area. Mean scores for knowledge, attitudes, and practices were 10.56 (SD 2.86), 1.24 (SD 0.83), and 3.17 (SD 1.5), respectively. Among the 492 respondents, 273 (55.5%) had poor knowledge, and 251 (49%) expressed a negative attitude; 192 out of 359 respondents (53.5%) had poor practices toward COVID-19. Mean scores of knowledge, attitudes, and practices differed significantly across various demographic and socioeconomic groups. Rural residents had lower mean scores of knowledge (mean 9.8, SD 3.1, P<.001) and adherence to appropriate practice measures (mean 4, SD 1.4, P<.001) compared to their urban counterparts. Positive and statistically strong correlations between knowledge and attitudes (r=0.21, P<.001), knowledge and practices (r=0.45, P<.001), and attitudes and practices (r=0.27, P<.001) were observed. Television (53.7%) was identified as the major source of knowledge regarding COVID-19. Almost three-quarters of the respondents (359/492, 73%) went outside the home during the lockdown period. Furthermore, the study found that good knowledge (odds ratio [OR] 3.13, 95% CI 2.03-4.83, and adjusted OR 2.33, 95% CI 1.16-4.68) and a positive attitude (OR 2.43, 95% CI 1.59-3.72, and adjusted OR 3.87, 95% CI 1.95-7.68) are significantly associated with better practice of COVID-19 health measures. Conclusions: Evidence-informed and context-specific risk communication and community engagement, and a social and behavior change communication strategy against COVID-19 should be developed in Bangladesh based on the findings of this study, targeting different socioeconomic groups. %M 34519660 %R 10.2196/28344 %U https://formative.jmir.org/2021/11/e28344 %U https://doi.org/10.2196/28344 %U http://www.ncbi.nlm.nih.gov/pubmed/34519660 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e20970 %T WhatsApp-Based Focus Groups Among Mexican-Origin Women in Zika Risk Area: Feasibility, Acceptability, and Data Quality %A Anderson,Elizabeth %A Koss,Mary %A Castro Luque,Ana Lucía %A Garcia,David %A Lopez,Elise %A Ernst,Kacey %+ Department of Health Promotion Sciences, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85721, United States, 1 5205050040, andersone@email.arizona.edu %K WhatsApp %K synchronous text-based focus groups %K Zika %K Mexican-origin Latinas %K social media %K mHealth %K focus groups %K smartphones %K mobile phone %D 2021 %7 28.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite unprecedented advances in worldwide access to the internet via smartphones, barriers to engaging hard-to-reach populations remain in many methods of health research. A potential avenue for conducting qualitative research is via participatory web-based media, including the free, popular social platform WhatsApp. However, despite the clear advantages of engaging with participants over a well-established web-based platform, logistical challenges remain. Objective: This study aims to report evidence on the feasibility and acceptability of WhatsApp as a method to conduct focus groups. Methods: A pilot focus group was conducted with Spanish-speaking women near the US–Mexico border. The content focus was knowledge and perceived risks for exposure to the Zika virus during pregnancy. Results: Evidence was obtained regarding WhatsApp as a low-cost, logistically feasible methodology that resulted in rich qualitative data from a population that is often reticent to engage in traditional research. A total of 5 participants participated in a focus group, of whom all 5 consistently contributed to the focus group chat in WhatsApp, which was conducted over 3 consecutive days. Conclusions: The findings are noteworthy at a time when face-to-face focus groups, the gold standard, are risky or precluded by safe COVID-19 guidelines. Other implications include more applications and evaluations of WhatsApp for delivering one-on-one or group health education interventions on sensitive topics. This paper outlines the key steps and considerations for the replication or adaptation of methods. %M 34709185 %R 10.2196/20970 %U https://formative.jmir.org/2021/10/e20970 %U https://doi.org/10.2196/20970 %U http://www.ncbi.nlm.nih.gov/pubmed/34709185 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e23648 %T The Potential of Digital Data Collection Tools for Long-lasting Insecticide-Treated Net Mass Campaigns in Nigeria: Formative Study %A Jo,Youngji %A Barthel,Nathan %A Stierman,Elizabeth %A Clifton,Kathryn %A Pak,Esther Semee %A Ezeiru,Sonachi %A Ekweremadu,Diwe %A Onugu,Nnaemeka %A Ali,Zainab %A Egwu,Elijah %A Akoh,Ochayi %A Uzunyayla,Orkan %A Van Hulle,Suzanne %+ Boston Medical Center, One Boston Medical Center Pl, Boston, MA, 02118, United States, 1 4438001626, youngji1435@gmail.com %K long-lasting insecticide-treated nets %K malaria %K Nigeria %K information communication technology %K geographic information system %K supply chain management %D 2021 %7 8.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Nigeria has the world’s largest malaria burden, accounting for 27% of the world’s malaria cases and 23% of malaria mortality globally. This formative study describes the operational process of the mass distribution of long-lasting insecticide-treated nets (LLINs) during a campaign program in Nigeria. Objective: This study aims to assess whether and how digital data collection and management tools can change current practices and help resolve major implementation issues. Methods: Qualitative data on the technical features and operational processes of paper-based and information and communication technology (ICT)–based systems in the Edo and Kwara states from June 2 to 30, 2017, were collected on the basis of documented operation manuals, field observations, and informant interviews. During the LLIN campaign in Edo State, we recruited 6 local government area focal persons and monitors and documented daily review meetings during household mobilization (9 days) and net distribution (5 days) to understand the major program implementation issues associated with the following three aspects: logistic issues, technical issues, and demand creation. Each issue was categorized according to the expected degree (low, mid, and high) of change by the ICT system. Results: The net campaign started with microplanning and training, followed by a month-long implementation process, which included household mobilization, net movement, net distribution, and end process monitoring. The ICT system can improve management and oversight issues related to data reporting and processes through user-centered interface design, built-in data quality control logic flow or algorithms, and workflow automation. These often require more than 50% of staff time and effort in the current paper-based practice. Compared with the current paper-based system, the real-time system is expected to reduce the time to payment compensation for health workers by about 20 days and produce summary campaign statistics for at least 20 to 30 days. Conclusions: The ICT system can facilitate the measurement of population coverage beyond program coverage during an LLIN campaign with greater data reliability and timeliness, which are often compromised due to the limited workforce capacity in a paper-based system. %M 34623310 %R 10.2196/23648 %U https://formative.jmir.org/2021/10/e23648 %U https://doi.org/10.2196/23648 %U http://www.ncbi.nlm.nih.gov/pubmed/34623310 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e31578 %T Improving the Follow-up Rate for Pediatric Patients (0-16 years) of an Eye Hospital in Nepal: Protocol for a Public Health Intervention Study %A Shrestha,Manisha %A Bhandari,Gopal %A Rathi,Suresh Kumar %A Gudlavalleti,Anirudh Gaurang %A Pandey,Binod %A Ghimire,Ramesh %A Ale,Daman %A Kayastha,Sajani %A Chaudhary,Daya Shankar %A Byanju,Raghunandan %A , %+ Bharatpur Eye Hospital, Bypass Rd-10, Bharatpur Metropolitan City, Chitwan, 42201, Nepal, 977 984 502 3273, maneeshasht9845@gmail.com %K counseling %K follow-up %K intervention study %K pediatric patients %K ophthalmology %K public health %K Nepal %D 2021 %7 8.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The follow-up of pediatric patients ensures regular ocular morbidity monitoring and better treatment outcome. Hiralal Santudevi Pradhan Institute of Ophthalmic Science (Bharatpur Eye Hospital [BEH]) noticed that the follow-up rate was only 22% among its pediatric patients. Several factors like lack of awareness and forgetfulness among patients may contribute to a lower number of follow-up visits. Therefore, BEH decided to find if counseling and reminders through SMS text messaging and phone calls would improve the follow-up rates. Objective: This study aims to evaluate the impact of interventions like counseling and reminder SMS text messaging and phone calls in improving the follow-up rate of pediatric patients. Methods: This is a public health intervention study being conducted using quantitative analysis. All children (0-16 years) with ocular conditions requiring at least 3 follow-up visits in the study period will be included. In all, 264 participants will be allocated to 3 groups: routine standard care, counseling, and reminders with SMS text messaging and phone calls. In counseling, patients will take part in 20-minute counseling sessions with trained counselors at each visit, and information leaflets will be provided to them. In the reminder SMS text messaging and phone call group, patients will receive an SMS text message 3 days prior and a phone call 1 day prior to their scheduled visits. Patients attending within 2 days of the scheduled date will be considered compliant to follow-up. The proportion of patients completing all the follow-up visits in each group will be assessed. Informed consent will be taken from parents and children. Univariate and multivariate analyses will be conducted. Results: The ethical approval for this study has been obtained from the Ethical Review Board (ERB) of Nepal Health Research Council (ERB protocol registration #761/2020 P). The data collection was initiated on January, 24, 2021, but due to the COVID-19 pandemic, as of September 2021, we have only been able to enroll 154 of the planned 264 participants (58.3% of the sample size). Conclusions: This study will reliably document not only the factors associated with follow-up rate through an intervention package (counseling and reminders through SMS text messaging and phone calls) but also the cost effectiveness of the intervention package, which can be applied in all the departments of the hospital. Trial Registration: ClinicalTrials.gov NCT04837534; https://clinicaltrials.gov/ct2/show/NCT04837534 International Registered Report Identifier (IRRID): DERR1-10.2196/31578 %M 34521615 %R 10.2196/31578 %U https://www.researchprotocols.org/2021/10/e31578 %U https://doi.org/10.2196/31578 %U http://www.ncbi.nlm.nih.gov/pubmed/34521615 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e26980 %T Knowledge, Attitudes, and Practices Regarding COVID-19 Among Health Care Workers in Public Health Facilities in Eastern Ethiopia: Cross-sectional Survey Study %A Farah,Alinoor Mohamed %A Nour,Tahir Yousuf %A Obsiye,Muse %A Aden,Mowlid Akil %A Ali,Omar Moeline %A Hussein,Muktar Arab %A Budul,Abdullahi Bedel %A Omer,Muktar %A Getnet,Fentabil %+ Department of Public Health Nutrition, School of Public Health, College of Medicine and Health Sciences, Jigjiga University, CoMHS Building, 2nd Floor, Jigjiga, 1020, Ethiopia, 251 911053913, alinuriana@yahoo.com %K COVID-19 %K knowledge %K attitude %K practice %K health care workers %K Eastern Ethiopia %D 2021 %7 1.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: On March 13, 2020, Ethiopia reported the first confirmed case of COVID-19 in Addis Ababa. COVID-19 is likely to overwhelm an already-fragile health care delivery system and reduce the availability of essential health services. This analysis of data from the Somali Region of Eastern Ethiopia on health care workers’ (HCWs) knowledge, attitudes, and practices regarding the prevention and control of COVID-19 may be used in planning health education programs about the emerging viral disease. Objective: This study aimed to investigate the knowledge, attitudes, and practices of HCWs regarding COVID-19 infection. Methods: This cross-sectional study was conducted among HCWs in three public health facilities in the Somali Region, Eastern Ethiopia. A self-administered questionnaire was shared with all HCWs working at the public health facilities. A total of 15 knowledge questions were scored as 1 or 0 for correct or incorrect responses, respectively. A total of 14 practice questions were scored on a 3-point scale from 1 (“always”) to 3 (“never”). A total of six attitude questions were rated on a 5-point Likert scale, in a negative dimension, as follows: 1 (“strongly agree”), 2 (“agree”), 3 (“neutral”), 4 (“disagree”), and 5 (“strongly disagree”). Mean scores were calculated and used as a cut point to dichotomize the outcome variables (>13.7 indicated good knowledge, <18.8 indicated good practices, and ≤10.5 indicated favorable attitudes). We used t tests and analyses of variance (ie, F tests) to analyze the mean score differences of knowledge, attitudes, and practices between the independent variables. Spearman correlation was used to assess the relationship between mean knowledge and attitude scores. Results: Of the 686 HCWs approached, a total of 434 HCWs responded (63.3% response rate). The mean age of the participants was 27.6 (SD 5.3) years, and the majority of the participants were male (293/434, 67.5%). The mean knowledge score was 13.7 (SD 2.6), and 73.3% (318/434) of participants had sufficient knowledge. The mean attitude score was 10.5 (SD 4.1), and 54.8% (238/434) of the participants had a good attitude toward COVID-19. The mean practice score was 18.8 (SD 5.8), and 61.5% (267/434) of the participants practiced precautionary measures to prevent COVID-19. There was a negative correlation between knowledge and attitude scores (r=–0.295, P<.001) and between knowledge and practice scores (r=–0.298, P<.001). Conclusions: The overall levels of knowledge and practice were relatively better than the attitude level. This highlights the need to implement strategies that enhance the positive attitudes and safe practices of the HCWs for better containment of the pandemic and supporting of essential health care services. %M 34477559 %R 10.2196/26980 %U https://formative.jmir.org/2021/10/e26980 %U https://doi.org/10.2196/26980 %U http://www.ncbi.nlm.nih.gov/pubmed/34477559 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e30692 %T The Pandemic Year 2020: World Map of Coronavirus Research %A Klingelhöfer,Doris %A Braun,Markus %A Brüggmann,Dörthe %A Groneberg,David A %+ Institute of Occupational, Social and Environmental Medicine, Goethe University, Theodor-Stern-Kai 7, Frankfurt, 60590, Germany, 49 69 63016650, klingelhoefer@med.uni-frankfurt.de %K COVID-19 %K SARS-CoV-2 %K incidence, research funding %K socioeconomic factors %K bibliometrics %K bibliometric analysis %K global health %K public health %K health database %K online research %K research database %D 2021 %7 8.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: SARS-CoV-2 is one of the most threatening pandemics in human history. As of the date of this analysis, it had claimed about 2 million lives worldwide, and the number is rising sharply. Governments, societies, and scientists are equally challenged under this burden. Objective: This study aimed to map global coronavirus research in 2020 according to various influencing factors to highlight incentives or necessities for further research. Methods: The application of established and advanced bibliometric methods combined with the visualization technique of density-equalizing mapping provided a global picture of incentives and efforts on coronavirus research in 2020. Countries’ funding patterns and their epidemiological and socioeconomic characteristics as well as their publication performance data were included. Results: Research output exploded in 2020 with momentum, including citation and networking parameters. China and the United States were the countries with the highest publication performance. Globally, however, publication output correlated significantly with COVID-19 cases. Research funding has also increased immensely. Conclusions: Nonetheless, the abrupt decline in publication efforts following previous coronavirus epidemics should demonstrate to global researchers that they should not lose interest even after containment, as the next epidemiological challenge is certain to come. Validated reporting worldwide and the inclusion of low-income countries are additionally important for a successful future research strategy. %M 34346891 %R 10.2196/30692 %U https://www.jmir.org/2021/9/e30692 %U https://doi.org/10.2196/30692 %U http://www.ncbi.nlm.nih.gov/pubmed/34346891 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28356 %T An Evaluation Service for Digital Public Health Interventions: User-Centered Design Approach %A Karpathakis,Kassandra %A Libow,Gene %A Potts,Henry W W %A Dixon,Simon %A Greaves,Felix %A Murray,Elizabeth %+ Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, United Kingdom, 44 20 3549 5303, h.potts@ucl.ac.uk %K digital health %K internet-based interventions %K mHealth %K evaluation studies %K public health %K human-centered design %K service design %K mobile phone %D 2021 %7 8.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health interventions (DHIs) have the potential to improve public health by combining effective interventions and population reach. However, what biomedical researchers and digital developers consider an effective intervention differs, thereby creating an ongoing challenge to integrating their respective approaches when evaluating DHIs. Objective: This study aims to report on the Public Health England (PHE) initiative set out to operationalize an evaluation framework that combines biomedical and digital approaches and demonstrates the impact, cost-effectiveness, and benefit of DHIs on public health. Methods: We comprised a multidisciplinary project team including service designers, academics, and public health professionals and used user-centered design methods, such as qualitative research, engagement with end users and stakeholders, and iterative learning. The iterative approach enabled the team to sequentially define the problem, understand user needs, identify opportunity areas, develop concepts, test prototypes, and plan service implementation. Stakeholders, senior leaders from PHE, and a working group critiqued the outputs. Results: We identified 26 themes and 82 user needs from semistructured interviews (N=15), expressed as 46 Jobs To Be Done, which were then validated across the journey of evaluation design for a DHI. We identified seven essential concepts for evaluating DHIs: evaluation thinking, evaluation canvas, contract assistant, testing toolkit, development history, data hub, and publish health outcomes. Of these, three concepts were prioritized for further testing and development, and subsequently refined into the proposed PHE Evaluation Service for public health DHIs. Testing with PHE’s Couch-to-5K app digital team confirmed the viability, desirability, and feasibility of both the evaluation approach and the Evaluation Service. Conclusions: An iterative, user-centered design approach enabled PHE to combine the strengths of academic and biomedical disciplines with the expertise of nonacademic and digital developers for evaluating DHIs. Design-led methodologies can add value to public health settings. The subsequent service, now known as Evaluating Digital Health Products, is currently in use by health bodies in the United Kingdom and is available to others for tackling the problem of evaluating DHIs pragmatically and responsively. %M 34494965 %R 10.2196/28356 %U https://www.jmir.org/2021/9/e28356 %U https://doi.org/10.2196/28356 %U http://www.ncbi.nlm.nih.gov/pubmed/34494965 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e23437 %T Evaluation of the Prevalence, Regional Phenotypic Variation, Comorbidities, Risk Factors, and Variations in Response to Different Therapeutic Modalities Among Indian Women: Proposal for the Indian Council of Medical Research–Polycystic Ovary Syndrome (ICMR–PCOS) Study %A Ganie,Mohd Ashraf %A Chowdhury,Subhankar %A Suri,Vanita %A Joshi,Beena %A Bhattacharya,Prasanta Kumar %A Agrawal,Sarita %A Malhotra,Neena %A Sahay,Rakesh %A Rozati,Roya %A Jabbar,Puthiyaveettil Khadar %A Sreenivas,Vishnubhatla %A Sriwastva,Mukesh %A Wani,Imtiyaz Ahmad %A Singh,Shalini %A Sharma,Radhey Shyam %+ Department of Endocrinology & Clinical Research, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, 190011, India, 91 9419041546, ashraf.endo@gmail.com %K polycystic ovary syndrome %K prevalence %K metabolic aberrations %K community pool %K therapeutic modalities %K India %K metabolic dysfunction %K phenotypic variations %K ovarian morphology %K PCOS epidemiology %D 2021 %7 27.8.2021 %9 Proposal %J JMIR Res Protoc %G English %X Background: There is scanty data in India on polycystic ovary syndrome (PCOS) from several small, undersized, convenience-based studies employing differing diagnostic criteria and reporting varied regional prevalence. It is difficult to draw clear-cut conclusions from these studies; therefore, the present multicentric, well-designed, large-scale representative countrywide epidemiological study on PCOS across India was conceived with the aim to generate the actual prevalence rates of PCOS in India with a total sample size of approximately 9000 individuals. Objective: The primary objectives of the study are to estimate the national prevalence of PCOS in India and the burden of comorbidities and to compare the variation in efficacy of standard therapeutic modalities for metabolic dysfunction in women with PCOS. Methods: This multicentric umbrella study consists of three different substudies. Substudy 1 will involve recruitment of women aged 18-40 years using a multistage sampling technique from randomly selected polling booths across urban and rural areas to estimate national prevalence, phenotypic variation, and risk factors among regions. Substudy 2 involves recruitment of subjects from the community pool of substudy 1 and the institutional pool for quantitation of comorbidities among women with PCOS. Substudy 3, an interventional part of the study, aims for comparison of variation in efficacies of common treatment modalities and will be conducted only at 2 centers. The eligible consenting women will be randomized in a 1:1 ratio into 2 arms through a blinding procedure. All these women will undergo clinical, biochemical, and hormonal assessment at baseline and at 3 and 6 months. The data generated will be analyzed using the reliable statistical software SPSS (version 26). Results: The study is ongoing and is likely to be completed by April 2022. The data will be compiled and analyzed, and the results of the study will be disseminated through publications. Conclusions: The Indian Council of Medical Research–PCOS study is the first of its kind attempting to provide accurate and comprehensive data on prevalence of PCOS in India. Trial Registration: Clinical Trials Registry–India CTRI/2018/11/016252; ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=26366 International Registered Report Identifier (IRRID): DERR1-10.2196/23437 %M 34448720 %R 10.2196/23437 %U https://www.researchprotocols.org/2021/8/e23437 %U https://doi.org/10.2196/23437 %U http://www.ncbi.nlm.nih.gov/pubmed/34448720 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e25877 %T Developing a Risk Governance Framework on Radiological Emergency, Preparedness, and Response for Emergency Responders: Protocol for a Mixed Methods Study %A Abd Rahman,Anita %A Abdul Manaf,Rosliza %A Lim,Poh Ying %A Suppiah,Subapriya %A Juni,Muhammad Hanafiah %+ Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan, 43400, Malaysia, 60 123180272, anitaar@upm.edu.my %K emergency %K preparedness %K radiological %K risk governance %K risk practices %D 2021 %7 13.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Risk governance involves processes and mechanisms to understand how risk decisions are taken and executed. This concept has gained a reputation over time as being essential for emerging comprehensive management that defines the success of an organization. While guiding documents that explain the use of risk management related to nuclear safety and security are available worldwide, few locally conducted studies have explained risk governance practices in areas where hazard usage is known, such as in radiological emergencies. Objective: This paper describes a protocol that was used to determine several factors that influence emergency responders’ perceptions toward radiological risk practices and visualize the risk radiological framework for emergency preparedness and response. Methods: A mixed methods study with a convergent design was performed. A qualitative analysis was performed using a case study approach where 6 key informants were purposely sampled for in-depth interview, and a cross-sectional study involving a self-administered questionnaire was conducted among approximately 260 emergency respondents from national regulatory, research, and services organizations. NVivo (version 12, QSR International) was used to analyze the interview transcripts and emerging themes were identified through abductive coding. Simultaneously, multiple logistic regression analysis was used to determine significant predictors that form the equation model. Results: The study is still underway. Qualitative findings were based on transcript-coding that informed the relevant thematic analysis, while statistical analyses including multiple logistic regression analysis measured the adjusted odds ratio of significant variables for the equation model. The study is expected to conclude in late 2021. Conclusions: Important emerging themes and significant factors that are related to the emergency responders’ perceptions regarding radiological governance practices were determined through the convergent design. This potentially facilitated the development of a plausible radiological risk governance framework. Furthermore, our results will provide key insights that can be used in future studies. International Registered Report Identifier (IRRID): DERR1-10.2196/25877 %M 34398793 %R 10.2196/25877 %U https://www.researchprotocols.org/2021/8/e25877 %U https://doi.org/10.2196/25877 %U http://www.ncbi.nlm.nih.gov/pubmed/34398793 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e26388 %T A Modified Public Health Automated Case Event Reporting Platform for Enhancing Electronic Laboratory Reports With Clinical Data: Design and Implementation Study %A Mishra,Ninad %A Duke,Jon %A Karki,Saugat %A Choi,Myung %A Riley,Michael %A Ilatovskiy,Andrey V %A Gorges,Marla %A Lenert,Leslie %+ Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, US 12-2, Rm 2031, 1600 Clifton Road, Atlanta, GA, 30329, United States, 1 4047187483, oql7@cdc.gov %K public health surveillance %K sexually transmitted diseases %K gonorrhea %K chlamydia %K electronic case reporting %K electronic laboratory reporting %K health information interoperability %K fast healthcare interoperability resources %K electronic health records %K EHR %D 2021 %7 11.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Public health reporting is the cornerstone of public health practices that inform prevention and control strategies. There is a need to leverage advances made in the past to implement an architecture that facilitates the timely and complete public health reporting of relevant case-related information that has previously not easily been available to the public health community. Electronic laboratory reporting (ELR) is a reliable method for reporting cases to public health authorities but contains very limited data. In an earlier pilot study, we designed the Public Health Automated Case Event Reporting (PACER) platform, which leverages existing ELR infrastructure as the trigger for creating an electronic case report. PACER is a FHIR (Fast Health Interoperability Resources)-based system that queries the electronic health record from where the laboratory test was requested to extract expanded additional information about a case. Objective: This study aims to analyze the pilot implementation of a modified PACER system for electronic case reporting and describe how this FHIR-based, open-source, and interoperable system allows health systems to conduct public health reporting while maintaining the appropriate governance of the clinical data. Methods: ELR to a simulated public health department was used as the trigger for a FHIR-based query. Predetermined queries were translated into Clinical Quality Language logics. Within the PACER environment, these Clinical Quality Language logical statements were managed and evaluated against the providers’ FHIR servers. These predetermined logics were filtered, and only data relevant to that episode of the condition were extracted and sent to simulated public health agencies as an electronic case report. Design and testing were conducted at the Georgia Tech Research Institute, and the pilot was deployed at the Medical University of South Carolina. We evaluated this architecture by examining the completeness of additional information in the electronic case report, such as patient demographics, medications, symptoms, and diagnoses. This additional information is crucial for understanding disease epidemiology, but existing electronic case reporting and ELR architectures do not report them. Therefore, we used the completeness of these data fields as the metrics for enriching electronic case reports. Results: During the 8-week study period, we identified 117 positive test results for chlamydia. PACER successfully created an electronic case report for all 117 patients. PACER extracted demographics, medications, symptoms, and diagnoses from 99.1% (116/117), 72.6% (85/117), 70.9% (83/117), and 65% (76/117) of the cases, respectively. Conclusions: PACER deployed in conjunction with electronic laboratory reports can enhance public health case reporting with additional relevant data. The architecture is modular in design, thereby allowing it to be used for any reportable condition, including evolving outbreaks. PACER allows for the creation of an enhanced and more complete case report that contains relevant case information that helps us to better understand the epidemiology of a disease. %M 34383669 %R 10.2196/26388 %U https://www.jmir.org/2021/8/e26388 %U https://doi.org/10.2196/26388 %U http://www.ncbi.nlm.nih.gov/pubmed/34383669 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e15864 %T Health Impacts of Perchlorate and Pesticide Exposure: Protocol for Community-Engaged Research to Evaluate Environmental Toxicants in a US Border Community %A Trotter II,Robert %A Baldwin,Julie %A Buck,Charles Loren %A Remiker,Mark %A Aguirre,Amanda %A Milner,Trudie %A Torres,Emma %A von Hippel,Frank Arthur %+ Department of Anthropology, Northern Arizona University, 1395 Knoles Drive, Flagstaff, AZ, 86011, United States, 1 9283808684, robert.trotter@nau.edu %K community-engaged research %K endocrine disruption %K environmental contaminants %K health disparities %K toxic metal contamination %K perchlorates %K pesticides %K population health %K thyroid disease %D 2021 %7 11.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The Northern Arizona University (NAU) Center for Health Equity Research (CHER) is conducting community-engaged health research involving “environmental scans” in Yuma County in collaboration with community health stakeholders, including the Yuma Regional Medical Center (YRMC), Regional Center for Border Health, Inc. (RCBH), Campesinos Sin Fronteras (CSF), Yuma County Public Health District, and government agencies and nongovernmental organizations (NGOs) working on border health issues. The purpose of these efforts is to address community-generated environmental health hazards identified through ongoing coalitions among NAU, and local health care and research institutions. Objective: We are undertaking joint community/university efforts to examine human exposures to perchlorate and agricultural pesticides. This project also includes the parallel development of a new animal model for investigating the mechanisms of toxicity following a “one health” approach. The ultimate goal of this community-engaged effort is to develop interventions to reduce exposures and health impacts of contaminants in Yuma populations. Methods: All participants completed the informed consent process, which included information on the purpose of the study, a request for access to health histories and medical records, and interviews. The interview included questions related to (1) demographics, (2) social determinants of health, (3) health screening, (4) occupational and environmental exposures to perchlorate and pesticides, and (5) access to health services. Each participant provided a hair sample for quantifying the metals used in pesticides, urine sample for perchlorate quantification, and blood sample for endocrine assays. Modeling will examine the relationships between the concentrations of contaminants and hormones, demographics and social determinants of health, and health status of the study population, including health markers known to be impacted by perchlorate and pesticides. Results: We recruited 323 adults residing in Yuma County during a 1-year pilot/feasibility study. Among these, 147 residents were patients from either YRMC or RCBH with a primary diagnosis of thyroid disease, including hyperthyroidism, hypothyroidism, thyroid cancer, or goiter. The remaining 176 participants were from the general population but with no history of thyroid disorder. The pilot study confirmed the feasibility of using the identified community-engaged protocol to recruit, consent, and collect data from a difficult-to-access, vulnerable population. The demographics of the pilot study population and positive feedback on the success of the community-engaged approach indicate that the project can be scaled up to a broader study with replicable population health findings. Conclusions: Using a community-engaged approach, the research protocol provided substantial evidence regarding the effectiveness of designing and implementing culturally relevant recruitment and dissemination processes that combine laboratory findings and public health information. Future findings will elucidate the mechanisms of toxicity and the population health effects of the contaminants of concern, as well as provide a new animal model to develop precision medicine capabilities for the population. International Registered Report Identifier (IRRID): DERR1-10.2196/15864 %M 34383679 %R 10.2196/15864 %U https://www.researchprotocols.org/2021/8/e15864 %U https://doi.org/10.2196/15864 %U http://www.ncbi.nlm.nih.gov/pubmed/34383679 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e26854 %T Tobacco Control Policy Simulation Models: Protocol for a Systematic Methodological Review %A Huang,Vincy %A Head,Anna %A Hyseni,Lirije %A O'Flaherty,Martin %A Buchan,Iain %A Capewell,Simon %A Kypridemos,Chris %+ Department of Public Health, Policy and Systems, University of Liverpool, Whelan Building, Liverpool, L69 3GB, United Kingdom, 44 01517952664, vincyhwj@liverpool.ac.uk %K smoking %K modeling %K health policy %K policy making %K systematic review %D 2021 %7 26.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Tobacco control models are mathematical models predicting tobacco-related outcomes in defined populations. The policy simulation model is considered as a subcategory of tobacco control models simulating the potential outcomes of tobacco control policy options. However, we could not identify any existing tool specifically designed to assess the quality of tobacco control models. Objective: The aims of this systematic methodology review are to: (1) identify best modeling practices, (2) highlight common pitfalls, and (3) develop recommendations to assess the quality of tobacco control policy simulation models. Crucially, these recommendations can empower model users to assess the quality of current and future modeling studies, potentially leading to better tobacco policy decision-making for the public. This protocol describes the planned systematic review stages, paper inclusion and exclusion criteria, data extraction, and analysis. Methods: Two reviewers searched five databases (Embase, EconLit, PsycINFO, PubMed, and CINAHL Plus) to identify eligible studies published between July 2013 and August 2019. We included papers projecting tobacco-related outcomes with a focus on tobacco control policies in any population and setting. Eligible papers were independently screened by two reviewers. The data extraction form was designed and piloted to extract model structure, data sources, transparency, validation, and other qualities. We will use a narrative synthesis to present the results by summarizing model trends, analyzing model approaches, and reporting data input and result quality. We will propose recommendations to assess the quality of tobacco control policy simulation models using the findings from this review and related literature. Results: Data collection is in progress. Results are expected to be completed and submitted for publication by April 2021. Conclusions: This systematic methodological review will summarize the best practices and pitfalls existing among tobacco control policy simulation models and present a recommendation list of a high-quality tobacco control simulation model. A more standardized and quality-assured tobacco control policy simulation model will benefit modelers, policymakers, and the public on both model building and decision making. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020178146; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020178146 International Registered Report Identifier (IRRID): DERR1-10.2196/26854 %M 34309577 %R 10.2196/26854 %U https://www.researchprotocols.org/2021/7/e26854 %U https://doi.org/10.2196/26854 %U http://www.ncbi.nlm.nih.gov/pubmed/34309577 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e27686 %T Defining the Scope of Digital Public Health and Its Implications for Policy, Practice, and Research: Protocol for a Scoping Review %A Iyamu,Ihoghosa %A Gómez-Ramírez,Oralia %A Xu,Alice X T %A Chang,Hsiu-Ju %A Haag,Devon %A Watt,Sarah %A Gilbert,Mark %+ British Columbia Centre for Disease Control, 655 W12th Avenue, Vancouver, BC, V5Z 4R4, Canada, 1 604 707 5619, Mark.Gilbert@bccdc.ca %K digital health %K public health %K prevention %K scoping review %K protocol %D 2021 %7 30.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: There has been rapid development and application of digital technologies in public health domains, which are considered to have the potential to transform public health. However, this growing interest in digital technologies in public health has not been accompanied by a clarity of scope to guide policy, practice, and research in this rapidly emergent field. Objective: This scoping review seeks to determine the scope of digital health as described by public health researchers and practitioners and to consolidate a conceptual framework of digital public health. Methods: The review follows Arksey and O’Malley’s framework for conducting scoping reviews with improvements as suggested by Levac et al. The search strategy will be applied to Embase, Medline, and Google Scholar. A grey literature search will be conducted on intergovernmental agency websites and country-specific websites. Titles and abstracts will be reviewed by independent reviewers, while full-text reviews will be conducted by 2 reviewers to determine eligibility based on prespecified inclusion and exclusion criteria. The data will be coded in an iterative approach using the best-fit framework analysis methodology. Results: This research project received funding from the British Columbia Centre for Disease Control Foundation for Population and Public Health on January 1, 2020. The initial search was conducted on June 1, 2020 and returned 6953 articles in total. After deduplication, 4523 abstracts were reviewed, and 227 articles have been included in the review. Ethical approval is not required for this review as it uses publicly available data. Conclusions: We anticipate that the findings of the scoping review will contribute relevant evidence to health policy makers and public health practitioners involved in planning, funding, and delivering health services that leverage digital technologies. Results of the review will be strategically disseminated through publications in scientific journals, conferences, and engagement with relevant stakeholders. International Registered Report Identifier (IRRID): DERR1-10.2196/27686 %M 34255717 %R 10.2196/27686 %U https://www.researchprotocols.org/2021/6/e27686 %U https://doi.org/10.2196/27686 %U http://www.ncbi.nlm.nih.gov/pubmed/34255717 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e24446 %T Reporting of Differences in Taste Between Branded and Unbranded Cigarettes by Smokers Blinded to Cigarette Branding: Within-Person, Randomized Crossover Study %A BinDhim,Nasser F %A Althumiri,Nora A %A Basyouni,Mada H %A Almubark,Rasha A %A Alkhamaali,Zaied %A Banjar,Weam %A Zamakhshary,Mohammed %A AlKattan,Khaled M %+ Sharik Association for Health Research, 4 Anas ibn Malik, Riyadh, 11778, Saudi Arabia, 966 505435544, nora@althumiri.net %K smoking %K plain packaging %K sensory %K Saudi Arabia %K tobacco %K virtual reality %K cigarettes %D 2021 %7 14.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Saudi Arabia implemented a plain tobacco packaging regulation, one of the World Health Organization’s recommended initiatives to help reduce smoking rates, in August 2019. A few weeks after implementation, a large number of smokers complained via various media channels, especially social media (eg, Twitter), that an extreme change in cigarette taste had occurred, frequency of coughing had increased, and for some, shortness of breath had led to hospitalization. Objective: The main objective is to determine whether smokers blinded to cigarette branding report differences in taste between branded and unbranded cigarettes. The secondary objective is to observe the frequency of immediate cough or shortness of breath. Methods: This study employed a within-person, randomized crossover design that recruited current smokers 18 years and older who were cleared upon physical assessment before the experiment. Participants received 6 sequences of different random exposures (3 puffs) to 3 plain-packaged cigarettes (2 from their favorite brand and 1 from another brand as a control) and 3 branded cigarettes (2 from the favorite brand and 1 from another brand as a control). Participants wore virtual reality goggles accompanied by special software to alter visual reality and gloves to alter the touch sensation. Results: This study recruited 18 participants, measured at 6 time points, to produce 108 experiments. Participants were not able to identify the correct type of cigarettes (plain or branded, estimate of fixed effect=−0.01, P=.79). Moreover, there were no differences in the ability of the participants to identify their favorite brand (t107=−0.63, mean 0.47, P=.53). In terms of immediate coughing, out of the 108 experiments, 1 episode of short coughing was observed, which was attributed to the branded cigarette, not the plain-packaged cigarette. Conclusions: After controlling the visual and touch sensations, participants were not able to differentiate between branded and plain-packaged cigarettes in terms of taste or inducing immediate shortness of breath or cough. Interestingly, participants were not able to identify their favorite brand. %M 33988511 %R 10.2196/24446 %U https://formative.jmir.org/2021/5/e24446 %U https://doi.org/10.2196/24446 %U http://www.ncbi.nlm.nih.gov/pubmed/33988511 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e24407 %T Norms and Social Network–Centric Behavior Change Intervention (Nam Nalavazhvu) for Improved Toilet Usage in Peri-Urban Communities of Tamil Nadu: Protocol for a Cluster-Randomized Controlled Trial %A Ashraf,Sania %A Bicchieri,Cristina %A Delea,Maryann G %A Das,Upasak %A Chauhan,Kavita %A Kuang,Jinyi %A Shpenev,Alex %A Thulin,Erik %+ Center for Social Norms and Behavioral Dynamics, University of Pennsylvania, 3718 Locust Walk, McNeil Building, Philadelphia, PA, 19104, United States, 1 215 898 3023, cb36@sas.upenn.edu %K sanitation %K behavior change %K social norms %K toilet %D 2021 %7 3.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Inconsistent toilet usage is a continuing challenge in India. Despite the impact of social expectations on toilet usage, few programs and studies have developed theoretically grounded norm-centric behavior change interventions to increase toilet use in low-income settings. Objective: The objective of this paper is to detail the rationale and design of an ex ante, parallel cluster-randomized trial evaluating the impact of a demand-side, norm-centric behavior change intervention on exclusive toilet use and maintenance in peri-urban Tamil Nadu, India. Methods: Following formative research, we developed an evidence-based norm-centric behavior change intervention called Nam Nalavazhvu (Tamil for “our well-being”). The multilevel intervention aims to improve toilet usage by shifting empirical expectations or beliefs about other relevant people’s sanitation practices. It also provides action-oriented information to aid individuals to set goals and overcome barriers to own, consistently use, and maintain their toilets. This trial includes 76 wards in the Pudukkottai and Karur districts, where half were randomly assigned to receive the intervention and the remaining served as counterfactuals. Results: We enrolled wards and conducted a baseline survey among randomly selected individuals in all 76 wards. The 1-year behavior change intervention is currently ongoing. At the endline, we will collect relevant data and compare results between study arms to determine the impacts of the Nam Nalavazhvu intervention on sanitation-related behavioral, health, and well-being outcomes and potential moderators. This study is powered to detect differences in the prevalence of exclusive toilet use between study arms. We are also conducting a process evaluation to understand the extent to which the intervention was implemented as designed, given the special pandemic context. Conclusions: Findings from this trial will inform norm-centric behavior change strategies to improve exclusive toilet usage. Trial Registration: ClinicalTrials.gov NCT04269824; https://www.clinicaltrials.gov/ct2/show/NCT04269824 International Registered Report Identifier (IRRID): DERR1-10.2196/24407 %M 33938805 %R 10.2196/24407 %U https://www.researchprotocols.org/2021/5/e24407 %U https://doi.org/10.2196/24407 %U http://www.ncbi.nlm.nih.gov/pubmed/33938805 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 4 %P e27419 %T Returning to a Normal Life via COVID-19 Vaccines in the United States: A Large-scale Agent-Based Simulation Study %A Li,Junjiang %A Giabbanelli,Philippe %+ Department of Computer Science & Software Engineering, Miami University, 205 Benton Hall, Oxford, OH, 45056, United States, 1 513 529 0147, aqualonne@free.fr %K agent-based model %K cloud-based simulations %K COVID-19 %K large-scale simulations %K vaccine %K model %K simulation %K United States %K agent-based %K effective %K willingness %K capacity %K plan %K strategy %K outcome %K interaction %K intervention %K scenario %K impact %D 2021 %7 29.4.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: In 2020, COVID-19 has claimed more than 300,000 deaths in the United States alone. Although nonpharmaceutical interventions were implemented by federal and state governments in the United States, these efforts have failed to contain the virus. Following the Food and Drug Administration's approval of two COVID-19 vaccines, however, the hope for the return to normalcy has been renewed. This hope rests on an unprecedented nationwide vaccine campaign, which faces many logistical challenges and is also contingent on several factors whose values are currently unknown. Objective: We study the effectiveness of a nationwide vaccine campaign in response to different vaccine efficacies, the willingness of the population to be vaccinated, and the daily vaccine capacity under two different federal plans. To characterize the possible outcomes most accurately, we also account for the interactions between nonpharmaceutical interventions and vaccines through 6 scenarios that capture a range of possible impacts from nonpharmaceutical interventions. Methods: We used large-scale, cloud-based, agent-based simulations by implementing the vaccination campaign using COVASIM, an open-source agent-based model for COVID-19 that has been used in several peer-reviewed studies and accounts for individual heterogeneity and a multiplicity of contact networks. Several modifications to the parameters and simulation logic were made to better align the model with current evidence. We chose 6 nonpharmaceutical intervention scenarios and applied the vaccination intervention following both the plan proposed by Operation Warp Speed (former Trump administration) and the plan of one million vaccines per day, proposed by the Biden administration. We accounted for unknowns in vaccine efficacies and levels of population compliance by varying both parameters. For each experiment, the cumulative infection growth was fitted to a logistic growth model, and the carrying capacities and the growth rates were recorded. Results: For both vaccination plans and all nonpharmaceutical intervention scenarios, the presence of the vaccine intervention considerably lowers the total number of infections when life returns to normal, even when the population compliance to vaccines is as low as 20%. We noted an unintended consequence; given the vaccine availability estimates under both federal plans and the focus on vaccinating individuals by age categories, a significant reduction in nonpharmaceutical interventions results in a counterintuitive situation in which higher vaccine compliance then leads to more total infections. Conclusions: Although potent, vaccines alone cannot effectively end the pandemic given the current availability estimates and the adopted vaccination strategy. Nonpharmaceutical interventions need to continue and be enforced to ensure high compliance so that the rate of immunity established by vaccination outpaces that induced by infections. %M 33872188 %R 10.2196/27419 %U https://medinform.jmir.org/2021/4/e27419 %U https://doi.org/10.2196/27419 %U http://www.ncbi.nlm.nih.gov/pubmed/33872188 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e27883 %T Pesticide Exposure of Residents Living Close to Agricultural Fields in the Netherlands: Protocol for an Observational Study %A Figueiredo,Daniel M %A Krop,Esmeralda J M %A Duyzer,Jan %A Gerritsen-Ebben,Rianda M %A Gooijer,Yvonne M %A Holterman,Henk J %A Huss,Anke %A Jacobs,Cor M J %A Kivits,Carla M %A Kruijne,Roel %A Mol,Hans J G J %A Oerlemans,Arné %A Sauer,Pieter J J %A Scheepers,Paul T J %A van de Zande,Jan C %A van den Berg,Erik %A Wenneker,Marcel %A Vermeulen,Roel C H %+ Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 2, 3rd Fl, Utrecht, 3584 CM, Netherlands, 31 621867972, d.m.figueiredo@uu.nl %K pesticides %K agriculture %K residents %K pesticide exposure assessment %K environmental samples %K biomonitoring %K modeling %D 2021 %7 28.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Application of pesticides in the vicinity of homes has caused concern regarding possible health effects in residents living nearby. However, the high spatiotemporal variation of pesticide levels and lack of knowledge regarding the contribution of exposure routes greatly complicates exposure assessment approaches. Objective: The objective of this paper was to describe the study protocol of a large exposure survey in the Netherlands assessing pesticide exposure of residents living close (<250 m) to agricultural fields; to better understand possible routes of exposure; to develop an integrative exposure model for residential exposure; and to describe lessons learned. Methods: We performed an observational study involving residents living in the vicinity of agricultural fields and residents living more than 500 m away from any agricultural fields (control subjects). Residential exposures were measured both during a pesticide use period after a specific application and during the nonuse period for 7 and 2 days, respectively. We collected environmental samples (outdoor and indoor air, dust, and garden and field soils) and personal samples (urine and hand wipes). We also collected data on spraying applications as well as on home characteristics, participants' demographics, and food habits via questionnaires and diaries. Environmental samples were analyzed for 46 prioritized pesticides. Urine samples were analyzed for biomarkers of a subset of 5 pesticides. Alongside the field study, and by taking spray events and environmental data into account, we developed a modeling framework to estimate environmental exposure of residents to pesticides. Results: Our study was conducted between 2016 and 2019. We assessed 96 homes and 192 participants, including 7 growers and 28 control subjects. We followed 14 pesticide applications, applying 20 active ingredients. We collected 4416 samples: 1018 air, 445 dust (224 vacuumed floor, 221 doormat), 265 soil (238 garden, 27 fields), 2485 urine, 112 hand wipes, and 91 tank mixtures. Conclusions: To our knowledge, this is the first study on residents’ exposure to pesticides addressing all major nondietary exposure sources and routes (air, soil, dust). Our protocol provides insights on used sampling techniques, the wealth of data collected, developed methods, modeling framework, and lessons learned. Resources and data are open for future collaborations on this important topic. International Registered Report Identifier (IRRID): RR1-10.2196/27883 %M 33908892 %R 10.2196/27883 %U https://www.researchprotocols.org/2021/4/e27883 %U https://doi.org/10.2196/27883 %U http://www.ncbi.nlm.nih.gov/pubmed/33908892 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e23015 %T Phylogenetic and Mutational Analysis of Lassa Virus Strains Isolated in Nigeria: Proposal for an In Silico Study %A Kolawole,Daniel %A Raji,Hayatu %A Okeke,Malachy Ifeanyi %+ Department of Natural and Environmental Sciences, American University of Nigeria, Lamido Zubairu Way, Yola, , Nigeria, 234 8145545022, malachy.okeke@aun.edu.ng %K Arenavirus %K Bayesian phylogeny %K epidemic %K evolution %K Lassa virus %K Mammarenavirus %K marker gene %K molecular epidemiology %K mutations %K Nigeria %D 2021 %7 26.3.2021 %9 Proposal %J JMIR Res Protoc %G English %X Background: In 2018, the total number of Lassa fever cases in Nigeria was significantly higher than that observed in previous years. Hence, studies had attempted to determine the underlying cause. However, reports using phylogenetic methods to analyze this finding ruled out the emergence of potentially more transmissible Lassa virus strains or an increase in human-to-human viral transmission as the cause underlying the increase in cases. Two years later, the situation seems even worse as the number of confirmed cases has reached an all-time high according to situational reports released by the Nigerian Center for Disease Control. Objective: Considering the increasing trend of Lassa fever cases and related mortality, the major objective of this study is to map mutations within the genomes of Lassa virus isolates from 2018 and 2019 using the reference sequence available at the National Center for Biotechnology Information as a benchmark and compare them to the genomes of viruses isolated during 1969-2017. This study would also attempt to identify a viral marker gene for easier identification and grouping. Finally, the time-scaled evolution of Lassa virus in Nigeria will be reconstructed. Methods: After collecting the sequence data of Lassa virus isolates, Bayesian phylogenetic trees, a sequence identity matrix, and a single nucleotide polymorphism matrix will be generated using BEAST (version 2.6.2), Base-By-Base, and DIVEIN (a web-based tool for variant calling), respectively. Results: Mining and alignment of Lassa virus genome sequences have been completed, while mutational analysis and the reconstruction of time-scaled maximum clade credibility trees, congruence tests for inferred segments, and gene phylogeny analysis are ongoing. Conclusions: The findings of this study would further the current knowledge of the evolutionary history of the Lassa virus in Nigeria and would document the mutations in Nigerian isolates from 1969 to 2019. International Registered Report Identifier (IRRID): DERR1-10.2196/23015 %M 33769296 %R 10.2196/23015 %U https://www.researchprotocols.org/2021/3/e23015 %U https://doi.org/10.2196/23015 %U http://www.ncbi.nlm.nih.gov/pubmed/33769296 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 2 %P e23606 %T Electronic Health Record–Based Prediction of 1-Year Risk of Incident Cardiac Dysrhythmia: Prospective Case-Finding Algorithm Development and Validation Study %A Zhang,Yaqi %A Han,Yongxia %A Gao,Peng %A Mo,Yifu %A Hao,Shiying %A Huang,Jia %A Ye,Fangfan %A Li,Zhen %A Zheng,Le %A Yao,Xiaoming %A Li,Zhen %A Li,Xiaodong %A Wang,Xiaofang %A Huang,Chao-Jung %A Jin,Bo %A Zhang,Yani %A Yang,Gabriel %A Alfreds,Shaun T %A Kanov,Laura %A Sylvester,Karl G %A Widen,Eric %A Li,Licheng %A Ling,Xuefeng %+ Department of Surgery, Stanford University, S370 Grant Building, 300 Pasteur Drive, Stanford, CA, 94305, United States, 1 6504279198, bxling@stanford.edu %K cardiac dysrhythmia %K prospective case finding %K risk stratification %K electronic health records %D 2021 %7 17.2.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Cardiac dysrhythmia is currently an extremely common disease. Severe arrhythmias often cause a series of complications, including congestive heart failure, fainting or syncope, stroke, and sudden death. Objective: The aim of this study was to predict incident arrhythmia prospectively within a 1-year period to provide early warning of impending arrhythmia. Methods: Retrospective (1,033,856 individuals enrolled between October 1, 2016, and October 1, 2017) and prospective (1,040,767 individuals enrolled between October 1, 2017, and October 1, 2018) cohorts were constructed from integrated electronic health records in Maine, United States. An ensemble learning workflow was built through multiple machine learning algorithms. Differentiating features, including acute and chronic diseases, procedures, health status, laboratory tests, prescriptions, clinical utilization indicators, and socioeconomic determinants, were compiled for incident arrhythmia assessment. The predictive model was retrospectively trained and calibrated using an isotonic regression method and was prospectively validated. Model performance was evaluated using the area under the receiver operating characteristic curve (AUROC). Results: The cardiac dysrhythmia case-finding algorithm (retrospective: AUROC 0.854; prospective: AUROC 0.827) stratified the population into 5 risk groups: 53.35% (555,233/1,040,767), 44.83% (466,594/1,040,767), 1.76% (18,290/1,040,767), 0.06% (623/1,040,767), and 0.003% (27/1,040,767) were in the very low-risk, low-risk, medium-risk, high-risk, and very high-risk groups, respectively; 51.85% (14/27) patients in the very high-risk subgroup were confirmed to have incident cardiac dysrhythmia within the subsequent 1 year. Conclusions: Our case-finding algorithm is promising for prospectively predicting 1-year incident cardiac dysrhythmias in a general population, and we believe that our case-finding algorithm can serve as an early warning system to allow statewide population-level screening and surveillance to improve cardiac dysrhythmia care. %M 33595452 %R 10.2196/23606 %U http://medinform.jmir.org/2021/2/e23606/ %U https://doi.org/10.2196/23606 %U http://www.ncbi.nlm.nih.gov/pubmed/33595452 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 1 %P e24924 %T Machine Learning Prediction of Foodborne Disease Pathogens: Algorithm Development and Validation Study %A Wang,Hanxue %A Cui,Wenjuan %A Guo,Yunchang %A Du,Yi %A Zhou,Yuanchun %+ Computer Network Information Center, Chinese Academy of Sciences, No 4, South Fourth Street, Zhongguancun, Haidian District, Beijing, 100190, China, 86 15810134970, duyi@cnic.cn %K foodborne disease %K pathogens prediction %K machine learning %D 2021 %7 26.1.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Foodborne diseases have a high global incidence; thus, they place a heavy burden on public health and the social economy. Foodborne pathogens, as the main factor of foodborne diseases, play an important role in the treatment and prevention of foodborne diseases; however, foodborne diseases caused by different pathogens lack specificity in their clinical features, and there is a low proportion of actual clinical pathogen detection in real life. Objective: We aimed to analyze foodborne disease case data, select appropriate features based on analysis results, and use machine learning methods to classify foodborne disease pathogens to predict foodborne disease pathogens for cases where the pathogen is not known or tested. Methods: We extracted features such as space, time, and exposed food from foodborne disease case data and analyzed the relationships between these features and the foodborne disease pathogens using a variety of machine learning methods to classify foodborne disease pathogens. We compared the results of four models to obtain the pathogen prediction model with the highest accuracy. Results: The gradient boost decision tree model obtained the highest accuracy, with accuracy approaching 69% in identifying 4 pathogens: Salmonella, Norovirus, Escherichia coli, and Vibrio parahaemolyticus. By evaluating the importance of features such as time of illness, geographical longitude and latitude, and diarrhea frequency, we found that these features play important roles in classifying foodborne disease pathogens. Conclusions: Data analysis can reflect the distribution of some features of foodborne diseases and the relationships among the features. The classification of pathogens based on the analysis results and machine learning methods can provide beneficial support for clinical auxiliary diagnosis and treatment of foodborne diseases. %M 33496675 %R 10.2196/24924 %U http://medinform.jmir.org/2021/1/e24924/ %U https://doi.org/10.2196/24924 %U http://www.ncbi.nlm.nih.gov/pubmed/33496675 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e18229 %T Risk Factors and Prevalence of Dilated Cardiomyopathy in Sub-Saharan Africa: Protocol for a Systematic Review %A Fundikira,Lulu Said %A Chillo,Pilly %A van Laake,Linda W %A Mutagaywa,Reuben Kato %A Schmidt,Amand Floriaan %A Kamuhabwa,Appolinary %A Kwesigabo,Gideon %A Asselbergs,Folkert W %+ Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands, 31 887559408, L.W.vanLaake@umcutrecht.nl %K dilated cardiomyopathy %K cardiomyopathy %K heart failure %K cardiovascular risk factors %K sub-Saharan Africa %D 2021 %7 21.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cardiomyopathies, defined as diseases involving mainly the heart muscles, are linked to an estimated 5.9 of 100,000 deaths globally. In sub-Saharan Africa, cardiomyopathies constitute 21.4% of heart failure cases, with dilated cardiomyopathy (DCM) being the most common form. The etiology of DCM is heterogeneous and is broadly categorized as genetic or nongenetic, as well as a mixed disease in which genetics interact with intrinsic and environmental factors. Factors such as age, gender, family history, and ethnicity are nonmodifiable, whereas modifiable risk factors include poor nutrition, physical inactivity, and excessive alcohol consumption, among others. However, the relative contribution of the different risk factors to the etiology of DCM is not known in sub-Saharan Africa, and the prevalence of DCM among heart failure patients has not been systematically studied in the region. Objective: The aim of this review is to synthesize available literature from sub-Saharan Africa on the prevalence of DCM among patients with heart failure, as well as the literature on factors associated with DCM. This paper outlines the protocol that will be followed to conduct the systematic review. Methods: A limited search of the PubMed database will be performed to identify relevant keywords contained in the title, abstract, and subject descriptors using initial search terms “heart failure,” “cardiomyopathy,” and “sub-Saharan Africa.” These search terms and their synonyms will then be used in an extensive search in PubMed, and will address the first research question on prevalence. To address the second research question on risk factors, the terms “heart failure,” “cardiomyopathy,” and “cardiovascular risk factors” in “Sub-Saharan Africa” will be used, listing them one by one. Articles published from 2000 and in the English language will be included. Indexed articles in PubMed and Embase will be included, as well as the first 300 articles retrieved from a Google Scholar search. Collected data will be organized in Endnote and then uploaded to the Rayyan web app for systematic reviews. Two reviewers will independently select articles against the inclusion criteria. Discrepancies in reviewer selections will be resolved by an arbitrator. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for reporting systematic reviews will be applied. A map of sub-Saharan Africa with colors to show disease prevalence in each country will be included. For quantitative data, where possible, odds ratios (for categorical outcome data) or standardized mean differences (for continuous data) and their 95% CIs will be calculated. Results: The primary outcomes will be the prevalence of DCM among patients with heart failure and cardiovascular risk factors associated with DCM in sub-Saharan Africa. The literature search will begin on January 1, 2021, and data analysis is expected to be completed by April 30, 2021. Conclusions: This review will provide information on the current status of the prevalence and associated factors of DCM, and possibly identify gaps, including paucity of data or conflicting results that need to be addressed to improve our understanding of DCM in sub-Saharan Africa. International Registered Report Identifier (IRRID): PRR1-10.2196/18229 %M 33475522 %R 10.2196/18229 %U http://www.researchprotocols.org/2021/1/e18229/ %U https://doi.org/10.2196/18229 %U http://www.ncbi.nlm.nih.gov/pubmed/33475522 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 7 %N 2 %P e10428 %T Basic Life Support Knowledge Among a Nonmedical Population in Jeddah, Saudi Arabia: Cross-Sectional Study %A Subki,Ahmed Hussein %A Mortada,Hatan Hisham %A Alsallum,Mohammed Saad %A Alattas,Ali Taleb %A Almalki,Mohammed Ali %A Hindi,Muhab Mohammed %A Subki,Siham Hussein %A Alhejily,Wesam Awad %+ Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Al Sulaymaniyah, Jeddah,, Saudi Arabia, 966 560662735, ahs.subki@gmail.com %K basic life support %K BLS %K cardiopulmonary resuscitation %K CPR %K awareness %K public %K knowledge %K Jeddah %K Saudi Arabia %D 2018 %7 28.11.2018 %9 Original Paper %J Interact J Med Res %G English %X Background: Providing basic life support (BLS) at the site of an accident is crucial to increase the survival rates of the injured people. It is especially relevant when health care is far away. Objective: The aim of our study is to assess the BLS knowledge level of the Saudi Arabian population and identify influencing factors associated with level of knowledge about BLS. Methods: Our study is a cross-sectional descriptive study, which was conducted using a self-administered online questionnaire derived from the BLS practice test. The Saudi population was the target population. The questionnaire was divided into two parts: one contained demographic data and the second part contained questions to test the population’s perception about how to perform BLS techniques properly. The data were collected between July and August 2017. Statistically significant differences were defined as those with a P value <.05, and a score of five or more was considered a passing score on the second part. We used SPSS version 21 for data analysis. Results: Our study included 301 participants. Our participants’ BLS online exam scores ranged from 0 to 10, with a mean of 4.1 (SD 1.7). Only 39.2% (118/301) of the participants passed the test. The percentage of bachelor’s degree or higher holders constituted 60.1% (181/301) of the study population. In addition, higher income was significantly associated with higher scores on the test (P=.04). Conclusions: This study demonstrated that the theoretical knowledge level of BLS among the general population in Jeddah was below average. There is a critical need to increase the public’s exposure to BLS education through raising awareness campaigns and government-funded training programs that aim to curb the incidence of out-of-hospital cardiac arrest mortalities in the Saudi community. %M 30487122 %R 10.2196/10428 %U http://www.i-jmr.org/2018/2/e10428/ %U https://doi.org/10.2196/10428 %U http://www.ncbi.nlm.nih.gov/pubmed/30487122 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 7 %N 1 %P e11 %T Characteristics of Adults’ Use of Facebook and the Potential Impact on Health Behavior: Secondary Data Analysis %A Bosak,Kelly %A Park,Shin Hye %+ School of Nursing, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mailstop 4043, Kansas City, KS, 66160, United States, 1 913 588 1656, kbosak@kumc.edu %K social media %K health promotion %K health behavior %K adults %D 2018 %7 14.06.2018 %9 Original Paper %J Interact J Med Res %G English %X Background: Social influences are a primary factor in the adoption of health behaviors. Social media platforms, such as Facebook, disseminate information, raise awareness, and provide motivation and support for positive health behaviors. Facebook has evolved rapidly and is now a part of many individuals' daily routine. The high degree of individual engagement and low attrition rate of this platform necessitate consideration for a potentially positive impact on health behavior. Objective: The aim of this paper is to investigate the use of Facebook by adults. Knowledge is limited to the unique characteristics of Facebook users, including time spent on Facebook by adults of various age groups. Characteristics of Facebook users are important to understand to direct efforts to engage adults in future health behavior interventions. Methods: Institutional Review Board approval was obtained for this secondary analysis of existing de-identified survey data collected for the Pew Research Center. The sample included adults age 18-65 years and above. Binomial logistic regression was performed for the model of age group and Facebook use, controlling for other demographics. A multinomial logistic regression model was used for the variable of time spent on Facebook. Based on the regression models, we computed and reported the marginal effects on Facebook use and time spent of adults age groups, including age groups 18-29, 30-49, 50-64, and 65 and over. We discuss these findings in the context of the implications for promoting positive health behaviors. Results: The demographics of the final sample (N=730) included adults age 18-65 years and above (mean 48.2 yrs, SD 18.3 yrs). The majority of the participants were female (372/730, 50.9%), white (591/730, 80.9%) and non-Hispanic (671/730, 91.9%). Bivariate analysis indicated that Facebook users and nonusers differed significantly by age group (χ2=76.71, P<.001) and sex (χ2=9.04, P=.003). Among subjects aged 50 and above, the predicted probability was 66% for spending the same amount of time, 10% with increased time, and 24% with decreased time. Conclusions: The key findings of this study were Facebook use among midlife and older adults was more likely to stay the same over time, compared to the other age groups. Interestingly, the young adult age group 18-29 years was more likely to decrease their time on Facebook over time. Specifically, younger females were most likely to decrease time spent on Facebook. In general, male participants were most likely to spend the same amount of time on Facebook. These findings have implications for future health intervention research, and ultimately, for translation to the clinic setting to improve health outcomes. %M 29903698 %R 10.2196/ijmr.9554 %U http://www.i-jmr.org/2018/1/e11/ %U https://doi.org/10.2196/ijmr.9554 %U http://www.ncbi.nlm.nih.gov/pubmed/29903698 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 6 %N 2 %P e24 %T How, When and Why People Seek Health Information Online: Qualitative Study in Hong Kong %A Chu,Joanna TW %A Wang,Man Ping %A Shen,Chen %A Viswanath,Kasisomayajula %A Lam,Tai Hing %A Chan,Sophia Siu Chee %+ School of Public Health, The University of Hong Kong, Patrick Manson Building, No 7, Sassoon Road, Hong Kong,, China (Hong Kong), 852 39179287, hrmrlth@hku.hk %K Internet %K information seeking behavior %K consumer health information %K focus groups %D 2017 %7 12.12.2017 %9 Original Paper %J Interact J Med Res %G English %X Background: The Internet has become an established source for health information. The number of individuals using the Internet to search for health information, ranging from healthy lifestyle advice to treatment and diseases, continues to grow. Scholars have emphasized the need to give greater voice and influence to health consumers. Hong Kong, being one of the most technologically advanced and connected cities in the world, has one of the highest Internet penetration rates in the world. Given the dearth of research in an Asian context, Hong Kong is an excellent platform to study individuals’ perceptions (eg, benefits and limitations on seeking health information online and how the information is used) on health information seeking. Objective: The aim of this paper was to study individuals’ perceptions on health information seeking and to document their Internet information–seeking behaviors. Methods: Five focus groups (n=49) were conducted from November 2015 to January 2016 with individuals across different age groups (18 years or above). Focus group contents were audiotaped, transcribed, and analyzed using thematic analysis techniques. Results: Older (55+ years) and less educated respondents were less likely to use the Internet to search for health information. Among individuals who obtained health information via the Internet, regardless of the severity of the health issue, the Internet was always the first source for information. Limited doctor consultation time and barriers to accessing professional health services were the main reasons for using the Internet. Convenience and coverage were regarded as the main advantages, whereas credibility and trustworthiness of health information were noted as limitations. The use of Web-based health information varied among individuals; hence, the implications on the doctor-patient relationship were mixed. Conclusions: The prevalent and increasing use of the Internet for health information seeking suggests the need for health care professionals to understand how it can be optimally utilized to improve health outcomes. Strategies for communicating and disseminating credible health information in a form that users can understand and use are essential. Due to the rapid technological and related behavioral changes, online health information seeking and its effects need to be closely monitored. %M 29233802 %R 10.2196/ijmr.7000 %U http://www.i-jmr.org/2017/2/e24/ %U https://doi.org/10.2196/ijmr.7000 %U http://www.ncbi.nlm.nih.gov/pubmed/29233802 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 6 %N 2 %P e9 %T Internet Use and Access, Behavior, Cyberbullying, and Grooming: Results of an Investigative Whole City Survey of Adolescents %A Vismara,Marco Flavio Michele %A Toaff,Joseph %A Pulvirenti,Giuliana %A Settanni,Chiara %A Colao,Emma %A Lavano,Serena Marianna %A Cemicetti,Riccardo %A Cotugno,David %A Perrotti,Giuseppe %A Meschesi,Viviana %A Montera,Roberto %A Zepponi,Barbara %A Rapetto,Umberto %A Marotta,Rosa %+ Graduate School of Medical Genetics XXVI Cycle, Dipartimento di Medicina Sperimentale della Facoltà di Medicina e Odontoiatria, Sapienza University, Viale Regina Elena, 324, Rome, 00161, Italy, 39 0658203494, marco@vismara.info %K adolescent %K Internet %K social media %K questionnaires %K data collection %D 2017 %7 29.08.2017 %9 Original Paper %J Interact J Med Res %G English %X Background: According to the Digital Agenda for Europe, the way children use the Internet and mobile technologies has changed dramatically in the past years. Objective: The aims of this study were to: (1) breakdown the modalities of access and use of the Internet by teenagers to assess risks and risky behaviors; and (2) provide scientific data to evaluate and counsel safe use of the Internet and new technologies by teenagers. Methods: The study was conducted under the program “Strategies for a Better Internet for Children” started in May 2012 by the European Commission. It represents the main result of the project launched by Telecom Italia, “Anche io ho qualcosa da dire” (I too have something to say), thanks to which many contributions were collected and used to develop a survey. The questionnaire was structured in 45 questions, covering three macro areas of interest. It was approved by the Department Board at University of Magna Graecia’s School of Medicine. After authorization from the regional high school authority, it was administered to all 1534 students (aged 13-19 years) in the city of Catanzaro, Italy. Results: The data was broken down into three main groups: (1) describing education and access to the Internet; (2) methods of use and social networking; and (3) perception and evaluation of risk and risky behaviors. Among noteworthy results in the first group, we can mention that the average age of first contact with information technologies was around 9 years. Moreover, 78.87% (1210/1534) of the interviewed students reported having access to a smartphone or a tablet. Among the results of the second group, we found that the most used social networks were Facebook (85.78%, 1316/1534), YouTube (61.14%, 938/1534), and Google+ (51.56%, 791/1534). About 71.31% (1094/1534) of the interviewed teenagers use their name and surname on social networks, and 40.09% (615/1534) of them knew all their Facebook contacts personally. Among the results of the third group, we found that 7.69% (118/1534) of the interviewed teenagers have uploaded pictures or movies of which they felt ashamed; 27.05% (415/1534) have received invitations from people they met on the Internet to meet in real life; and 8.67% (133/1534) have accepted such invitations. Conclusions: The results offer a breakdown of the teenagers’ use of the Internet, focusing on how teenagers learn to use and access it while taking into account factors such as parental coaching, schooling, or self-education. It describes how they approach and interact with social networks and how they perceive risks and risky behaviors on the Internet. Information technology must be seen as an instrument and not as a hindrance. For this to happen, parental guidance, schooling, and medical counseling are needed for a sound development of the child in this critical stage. %M 28851675 %R 10.2196/ijmr.6231 %U http://www.i-jmr.org/2017/2/e9/ %U https://doi.org/10.2196/ijmr.6231 %U http://www.ncbi.nlm.nih.gov/pubmed/28851675 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 5 %N 2 %P e20 %T Relationship Between Difficulties in Daily Activities and Falling: Loco-Check as a Self-Assessment of Fall Risk %A Akahane,Manabu %A Maeyashiki,Akie %A Yoshihara,Shingo %A Tanaka,Yasuhito %A Imamura,Tomoaki %+ Faculty of Medicine, Department of Public Health, Health Management and Policy, Nara Medical University, Shijo 840, Kashihara, Nara 6348521, Japan, 81 744 22 3051 ext 2224, makahane@naramed-u.ac.jp %K accidental falls %K disability evaluation %K self-assessment %K activity of daily living %D 2016 %7 20.06.2016 %9 Original Paper %J Interact J Med Res %G English %X Background: People aged 65 years or older accounted for 25.1% of the Japanese population in 2013, and this characterizes the country as a “super-aging society.” With increased aging, fall-related injuries are becoming important in Japan, because such injuries underlie the necessity for nursing care services. If people could evaluate their risk of falling using a simple self-check test, they would be able to take preventive measures such as exercise, muscle training, walking with a cane, or renovation of their surroundings to remove impediments. Loco-check is a checklist measure of early locomotive syndrome (circumstances in which elderly people need nursing care service or are at high risk of requiring the service within a short time), prepared by the Japanese Orthopaedic Association (JOA) in 2007, but it is unclear if there is any association between this measure and falls. Objective: To investigate the association between falls during the previous year and the 7 “loco-check” daily activity items and the total number of items endorsed, and sleep duration. Methods: We conducted an Internet panel survey. Subjects were 624 persons aged between 30 and 90 years. The general health condition of the participants, including their experience of falling, daily activities, and sleep duration, was investigated. A multivariate analysis was carried out using logistic regression to investigate the relationship between falls in the previous year and difficulties with specific daily activities and total number of difficulties (loco-check) endorsed, and sleep duration, adjusting for sex and age. Results: One-fourth of participants (157 persons) experienced at least one fall during the previous year. Fall rate of females (94/312: 30.1%) was significantly higher than that of males (63/312: 20.2%). Fall rate of persons aged more than 65 years (80/242: 33.1%) was significantly higher than that of younger persons (77/382: 20.2%). Logistic regression analysis revealed that daily activities such as “impossibility of getting across the road at a crossing before the traffic light changes” are significantly related to falling. Logistic regression analysis also demonstrated a relationship between the number of items endorsed on loco-check and incidence of falling, wherein persons who endorsed 4 or more items appear to be at higher risk for falls. However, logistic regression found no significant relationship between sleep duration and falling. Conclusions: Our study demonstrated a relationship between the number of loco-check items endorsed and the incidence of falling in the previous year. Endorsement of 4 or more items appeared to signal a high risk for falls. The short self-administered checklist can be a valuable tool for assessing the risk of falling and for initiating preventive measures. %M 27323871 %R 10.2196/ijmr.5590 %U http://www.i-jmr.org/2016/2/e20/ %U https://doi.org/10.2196/ijmr.5590 %U http://www.ncbi.nlm.nih.gov/pubmed/27323871 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 4 %N 3 %P e17 %T Understanding the Experiences of Rural Community-Dwelling Older Adults in Using a New DVD-Delivered Otago Exercise Program: A Qualitative Study %A Agha,Arun %A Liu-Ambrose,Teresa Y L %A Backman,Catherine L %A Leese,Jennifer %A Li,Linda C %+ University of British Columbia, 124-2177 Wesbrook Mall, Vancouver, BC, , Canada, 1 604 207 4020, lli@arthritisresearch.ca %K Otago Exercise Program %K DVD %K aging %K falls %K physical therapy %K qualitative research %D 2015 %7 13.08.2015 %9 Original Paper %J Interact J Med Res %G English %X Background: The home-based Otago Exercise Program (OEP) has been shown to reduce the occurrence of falls in community-dwelling seniors. A new OEP DVD was recently developed for people living in rural communities to be used with minimal coaching by a physical therapist. Objective: This study aimed to understand older adults’ experiences using the DVD-delivered OEP and explore barriers and facilitators to implementing the DVD-delivered OEP from the participants’ perspectives. Methods: Rural community-dwelling older adults (75 years and older) who participated in a six-month DVD-delivered OEP study were invited to participate in this qualitative study. Two small group interviews were initially conducted to explore the breadth of participants’ experiences with the program. These were followed by semi-structured individual interviews to gain an in-depth understanding of these experiences. An inductive constant comparison analysis of the transcripts was performed. To ensure methodological rigor, field notes, journaling, and an audit trail were maintained, supplemented by peer-review. Results: Of 32 eligible participants, five participated in group interviews and 16 in individual interviews. Three themes emerged. Theme 1, The OEP DVD—useful training tool but in need of more pep, represented participants’ experiences that the DVD provided important guidance at program onset, but was too slow and low-energy for longer-term use. Theme 2, Gaining control over one’s exercise regimen, but sometimes life gets in the way of staying active, described participants’ appreciation of the program’s flexibility, but personal health concerns and everyday lives posed challenges to adhering to the program. Theme 3, Social creatures—wanting greater human connection during exercise, described how some participants desired further social interactions for enhancing motivation and receiving guidance. Conclusions: Individuals should be encouraged to refer to the OEP user manual or DVD as needed and engage friends and family in exercises. The importance of exercise even when living with health problems should be raised at program onset, and participants should be supported in working through challenging issues. Health professionals should work with individuals to integrate the program with their everyday activities. %M 26272163 %R 10.2196/ijmr.4257 %U http://www.i-jmr.org/2015/3/e17/ %U https://doi.org/10.2196/ijmr.4257 %U http://www.ncbi.nlm.nih.gov/pubmed/26272163 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 1 %P e15 %T Knowledge, Attitudes, and Practices Regarding Avian Influenza A (H7N9) Among Mobile Phone Users: A Survey in Zhejiang Province, China %A Gu,Hua %A Jiang,Zhenggang %A Chen,Bin %A Zhang,Jueman (Mandy) %A Wang,Zhengting %A Wang,Xinyi %A Cai,Jian %A Chen,Yongdi %A Zheng,Dawei %A Jiang,Jianmin %+ Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou, 310051, China, 86 57187115009, jmjiang@cdc.zj.cn %K influenza A virus, subtype H7N9 %K knowledge %K attitude %K surveillance %D 2015 %7 04.02.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Understanding people’s knowledge, attitudes, and practices (KAP) regarding a new infectious disease is crucial to the prevention and control of it. Human infection with avian influenza A (H7N9) was first identified on March 31, 2013 in China. Out of the total number of 134 cases confirmed from March to September 2013 in China, Zhejiang Province saw the greatest number (46 cases). Objective: This study employed a mobile Internet survey to assess KAP regarding H7N9 among mobile phone users in Zhejiang Province. This study intended to examine KAP by region and the association between sociodemographic variables and KAP. Methods: An anonymous questionnaire was designed by Zhejiang Provincial Center for Disease Control and Prevention (CDC). A cross-sectional survey was executed through a mobile Internet application platform of China Unicom in 5 regions in Zhejiang Province. Stratified and clustered sampling methods were applied and mobile phone users were invited to participate in the study voluntarily. Results: A total of 9582 eligible mobile phone users participated in the survey with a response rate of 1.92% (9582/5,000,000). A total of 9105 valid responses (95.02%) were included for statistical analysis. Generally, more than three-quarters of the participants had some basic knowledge of H7N9 and held the attitude recommended by the Zhejiang CDC toward eating cooked poultry (77.55%, 7061/9105) and visiting a hospital at the occurrence of symptoms (78.51%, 7148/9105). Approximately half of the participants worried about contracting H7N9, and took preventive practices recommended by the Zhejiang CDC. But only 14.29% (1301/9105) of participants kept eating cooked poultry as usual. Although worry about H7N9 infection did not differ by region, Hangzhou saw the largest proportion of participants with knowledge of H7N9, which was probably because Hangzhou had the greatest number of H7N9 cases. KAP varied by some sociodemographic variables. Female participants were more likely to know about symptoms of H7N9 (OR 1.32, 95% CI 1.08-1.61), to worry about contracting it (OR 1.15, 95% CI 1.04-1.27), and to report their lives being influenced by it (OR 1.27, 95% CI 1.15-1.41). They were also more likely to take the recommended precautions. Male participants and younger participants were less likely to comply with advocated protective practices. Conclusions: The results suggest that health education should be customized depending on sociodemographic variables to achieve more effective behavioral outcomes. %M 25653213 %R 10.2196/mhealth.3394 %U http://mhealth.jmir.org/2015/1/e15/ %U https://doi.org/10.2196/mhealth.3394 %U http://www.ncbi.nlm.nih.gov/pubmed/25653213 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 4 %N 1 %P e3 %T Information Seeking in Social Media: A Review of YouTube for Sedentary Behavior Content %A Knight,Emily %A Intzandt,Brittany %A MacDougall,Alicia %A Saunders,Travis J %+ University of Western Ontario, Health and Rehabilitation Sciences, 1201 Western Road, London, ON, N6G 1H1, Canada, 1 519 685 4292, eknigh2@uwo.ca %K sedentary lifestyle %K translational medical research %K social media %D 2015 %7 20.01.2015 %9 Review %J Interact J Med Res %G English %X Background: The global prevalence of sedentary lifestyles is of grave concern for public health around the world. Moreover, the health risk of sedentary behaviors is of growing interest for researchers, clinicians, and the general public as evidence demonstrates that prolonged amounts of sedentary time increases risk for lifestyle-related diseases. There is a growing trend in the literature that reports how social media can facilitate knowledge sharing and collaboration. Social sites like YouTube facilitate the sharing of media content between users. Objective: The purpose of this project was to identify sedentary behavior content on YouTube and describe features of this content that may impact the effectiveness of YouTube for knowledge translation. Methods: YouTube was searched on a single day by 3 independent reviewers for evidence-based sedentary behavior content. Subjective data (eg, video purpose, source, and activity type portrayed) and objective data (eg, number of views, comments, shares, and length of the video) were collected from video. Results: In total, 106 videos met inclusion criteria. Videos were uploaded from 13 countries around the globe (ie, Australia, Barbados, Belgium, Canada, Colombia, Kenya, New Zealand, Russia, South Africa, Spain, Ukraine, United Kingdom, United States). The median video length was 3:00 minutes: interquartile range (IQR) 1:44-5:40. On average, videos had been on YouTube for 15.0 months (IQR 6.0-27.5) and had been viewed 239.0 times (IQR 44.5-917.5). Videos had remarkably low numbers of shares (median 0) and comments (median 1). Only 37.7% (40/106) of videos portrayed content on sedentary behaviors, while the remaining 66 videos portrayed physical activity or a mix of behaviors. Academic/health organizations (39.6%, 42/106) and individuals (38.7%, 41/106) were the most prevalent source of videos, and most videos (67.0%, 71/106) aimed to educate viewers about the topic. Conclusions: This study explored sedentary behavior content available on YouTube. Findings demonstrate that there is confusion between physical activity and sedentary behaviors, that content is being uploaded to the site from around the globe, that content is primarily from health organizations and individuals with the purpose of educating fellow users, but that low views, comments, and shares suggest that sedentary behavior content is relatively underutilized on YouTube. Future research may wish to leverage social platforms, such as YouTube, to facilitate implementation and sharing of evidence-based sedentary behavior content. %M 25604433 %R 10.2196/ijmr.3835 %U http://www.i-jmr.org/2015/1/e3/ %U https://doi.org/10.2196/ijmr.3835 %U http://www.ncbi.nlm.nih.gov/pubmed/25604433 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 3 %N 4 %P e15 %T Perceived Reasons, Incentives, and Barriers to Physical Activity in Swedish Elderly Men %A Sjörs,Camilla %A Bonn,Stephanie E %A Trolle Lagerros,Ylva %A Sjölander,Arvid %A Bälter,Katarina %+ Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Nobels väg 12a, Stockholm, 171 77, Sweden, 46 8 524 824 85, camilla.sjors@ki.se %K Internet %K exercise %K motivation %K barrier %K aged %K men %D 2014 %7 12.11.2014 %9 Original Paper %J Interact J Med Res %G English %X Background: Knowledge about factors influencing physical activity behavior is needed in order to tailor physical activity interventions to the individual. Objective: The aim of this study was to explore and describe the perceived reasons, barriers, and incentives to increased physical activity, as well as preferable activities, among elderly men in Sweden. Methods: In total, 150 men aged 50-86 years responded to a Web-based questionnaire. Men who reported that they exercised sometimes or often received questions about reasons for physical activity (n=104), while men who reported that they never or seldom exercised received questions about barriers (n=46). Results: The most frequent perceived reason for being physically active was health (82%), followed by enjoyment (45%), and a desire to lose/maintain weight (27%). Lack of interest/motivation was identified as the primary perceived barrier (17%). Incentives for increasing the level of activity included becoming more motivated and having a training partner. Walking was the most preferred activity. Conclusions: Enjoyment and maintaining a good health were important reasons for engaging in physical activity among Swedish elderly men. %M 25488655 %R 10.2196/ijmr.3191 %U http://www.i-jmr.org/2014/4/e15/ %U https://doi.org/10.2196/ijmr.3191 %U http://www.ncbi.nlm.nih.gov/pubmed/25488655 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 2 %N 2 %P e16 %T Using Business Intelligence to Analyze and Share Health System Infrastructure Data in a Rural Health Authority %A Haque,Waqar %A Urquhart,Bonnie %A Berg,Emery %A Dhanoa,Ramandeep %+ University of Northern British Columbia, Department of Computer Science and School of Business, 3333 University Way, Prince George, BC, V2N 4Z9, Canada, 1 250 960 6522, waqar.haque@unbc.ca %K business intelligence %K health care systems %K availability of health services %K data visualization %D 2014 %7 06.08.2014 %9 Original Paper %J JMIR Med Inform %G English %X Background: Health care organizations gather large volumes of data, which has been traditionally stored in legacy formats making it difficult to analyze or use effectively. Though recent government-funded initiatives have improved the situation, the quality of most existing data is poor, suffers from inconsistencies, and lacks integrity. Generating reports from such data is generally not considered feasible due to extensive labor, lack of reliability, and time constraints. Advanced data analytics is one way of extracting useful information from such data. Objective: The intent of this study was to propose how Business Intelligence (BI) techniques can be applied to health system infrastructure data in order to make this information more accessible and comprehensible for a broader group of people. Methods: An integration process was developed to cleanse and integrate data from disparate sources into a data warehouse. An Online Analytical Processing (OLAP) cube was then built to allow slicing along multiple dimensions determined by various key performance indicators (KPIs), representing population and patient profiles, case mix groups, and healthy community indicators. The use of mapping tools, customized shape files, and embedded objects further augment the navigation. Finally, Web forms provide a mechanism for remote uploading of data and transparent processing of the cube. For privileged information, access controls were implemented. Results: Data visualization has eliminated tedious analysis through legacy reports and provided a mechanism for optimally aligning resources with needs. Stakeholders are able to visualize KPIs on a main dashboard, slice-and-dice data, generate ad hoc reports, and quickly find the desired information. In addition, comparison, availability, and service level reports can also be generated on demand. All reports can be drilled down for navigation at a finer granularity. Conclusions: We have demonstrated how BI techniques and tools can be used in the health care environment to make informed decisions with reference to resource allocation and enhancement of the quality of patient care. The data can be uploaded immediately upon collection, thus keeping reports current. The modular design can be expanded to add new datasets such as for smoking rates, teen pregnancies, human immunodeficiency virus (HIV) rates, immunization coverage, and vital statistical summaries. %M 25599727 %R 10.2196/medinform.3590 %U http://medinform.jmir.org/2014/2/e16/ %U https://doi.org/10.2196/medinform.3590 %U http://www.ncbi.nlm.nih.gov/pubmed/25599727 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 3 %N 2 %P e9 %T A European Network of Email and Telephone Help Lines Providing Information and Support on Rare Diseases: Results From a 1-Month Activity Survey %A Houyez,Francois %A Sanchez de Vega,Rosa %A Brignol,Tuy Nga %A Mazzucato,Monica %A Polizzi,Agata %+ European Organisation for Rare Diseases (Eurordis), 96 rue Didot, 75014, Paris, , France, 33 156535218, francois.houyez@eurordis.org %K rare diseases %K help line %K social telephony %K health services planning %K health information %D 2014 %7 05.05.2014 %9 Original Paper %J Interact J Med Res %G English %X Background: Information on rare diseases are often complex to understand, or difficult to access and additional support is often necessary. Rare diseases helplines work together across Europe to respond to calls and emails from the public at large, including patients, health care professionals, families, and students. Measuring the activity of helplines can help decision makers to allocate adequate funds when deciding to create or expand an equivalent service. Objective: Data presented are referred to a monthly user profile analysis, which is one of the activities that each helpline has to carry out to be part of the network. This survey aimed to explore the information requests and characteristics of users of rare diseases helplines in different European countries. Another aim was to analyze these data with respect to users’ characteristics, helpline characteristics, topics of the inquiries, and technologies used to provide information. With this survey, we measure data that are key for planning information services on rare diseases in the context of the development of national plans for rare diseases. Methods: A survey was conducted based on all calls, emails, visits, or letters received from November 1 to 30, 2012 to monitor the activity represented by 12 helplines. Data were collected by a common standardized form, using ORPHA Codes for rare diseases, when applicable. No personal data identifying the inquirer were collected. It was a descriptive approach documenting on the number and purpose of inquiries, the number of respondents, the mode of contact, the category of the inquirer in relation to the patient, the inquirer’s gender, age and region of residence, the patient’s age when applicable, the type and duration of response, and the satisfaction as scored by the respondents. Results: A total of 1676 calls, emails, or letters were received from November 1 to 30, 2012. Inquiries were mostly about specific diseases. An average of 23 minutes was spent for each inquiry. The inquirer was a patient in 571/1676 inquiries (ie, 34.07% of all cases; 95% CI 31.8-36.3). Other inquirers included relatives (520/1676, 31.03%; 95% CI 28.9-33.3), health care professionals (354/1676, 21.12%; 95% CI 19.2-23.1), and miscellaneous inquirers (230/1676, 13.72%; 95% CI 12.1-15.4). Telephone remained the main mode of contact (988/1676, 58.95%; 95% CI 56.6-61.3), followed by emails (609/1676, 36.34%; 95% CI 34.0-38.6). The three main reasons of inquiries were to acquire about information on the disease (682/2242, 30.42%; 95% CI 27.8-32.1), a specialized center/expert (404/2242, 18.02%; 95% CI 15.9-19.6), and social care (240/2242, 10.70%; 95% CI 9.1-12.0). Conclusions: The helplines service responds to the demands of the public, however more inquiry-categories could be responded to. This leaves the possibility to expand the scope of the helplines, for example by providing assistance to patients when they are reporting suspected adverse drug reactions as provided by Directive 2010/84/EU or by providing information on patients’ rights to cross-border care, as provided by Directive 2010/24/EU. %M 24797216 %R 10.2196/ijmr.2867 %U http://www.i-jmr.org/2014/2/e9/ %U https://doi.org/10.2196/ijmr.2867 %U http://www.ncbi.nlm.nih.gov/pubmed/24797216 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 4 %P e116 %T Performance of eHealth Data Sources in Local Influenza Surveillance: A 5-Year Open Cohort Study %A Timpka,Toomas %A Spreco,Armin %A Dahlström,Örjan %A Eriksson,Olle %A Gursky,Elin %A Ekberg,Joakim %A Blomqvist,Eva %A Strömgren,Magnus %A Karlsson,David %A Eriksson,Henrik %A Nyce,James %A Hinkula,Jorma %A Holm,Einar %+ Department of Medical and Health Sciences, Linköping University, Linköping University Hospital Campus, Linköping, SE58183, Sweden, 46 101030000, toomas.timpka@liu.se %K influenza %K infectious disease surveillance %K Internet %K eHealth %K Google Flu Trends %K telenursing call centers %K website usage %K open cohort design %K public health %D 2014 %7 28.04.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: There is abundant global interest in using syndromic data from population-wide health information systems—referred to as eHealth resources—to improve infectious disease surveillance. Recently, the necessity for these systems to achieve two potentially conflicting requirements has been emphasized. First, they must be evidence-based; second, they must be adjusted for the diversity of populations, lifestyles, and environments. Objective: The primary objective was to examine correlations between data from Google Flu Trends (GFT), computer-supported telenursing centers, health service websites, and influenza case rates during seasonal and pandemic influenza outbreaks. The secondary objective was to investigate associations between eHealth data, media coverage, and the interaction between circulating influenza strain(s) and the age-related population immunity. Methods: An open cohort design was used for a five-year study in a Swedish county (population 427,000). Syndromic eHealth data were collected from GFT, telenursing call centers, and local health service website visits at page level. Data on mass media coverage of influenza was collected from the major regional newspaper. The performance of eHealth data in surveillance was measured by correlation effect size and time lag to clinically diagnosed influenza cases. Results: Local media coverage data and influenza case rates showed correlations with large effect sizes only for the influenza A (A) pH1N1 outbreak in 2009 (r=.74, 95% CI .42-.90; P<.001) and the severe seasonal A H3N2 outbreak in 2011-2012 (r=.79, 95% CI .42-.93; P=.001), with media coverage preceding case rates with one week. Correlations between GFT and influenza case data showed large effect sizes for all outbreaks, the largest being the seasonal A H3N2 outbreak in 2008-2009 (r=.96, 95% CI .88-.99; P<.001). The preceding time lag decreased from two weeks during the first outbreaks to one week from the 2009 A pH1N1 pandemic. Telenursing data and influenza case data showed correlations with large effect sizes for all outbreaks after the seasonal B and A H1 outbreak in 2007-2008, with a time lag decreasing from two weeks for the seasonal A H3N2 outbreak in 2008-2009 (r=.95, 95% CI .82-.98; P<.001) to none for the A p H1N1 outbreak in 2009 (r=.84, 95% CI .62-.94; P<.001). Large effect sizes were also observed between website visits and influenza case data. Conclusions: Correlations between the eHealth data and influenza case rates in a Swedish county showed large effect sizes throughout a five-year period, while the time lag between signals in eHealth data and influenza rates changed. Further research is needed on analytic methods for adjusting eHealth surveillance systems to shifts in media coverage and to variations in age-group related immunity between virus strains. The results can be used to inform the development of alert-generating eHealth surveillance systems that can be subject for prospective evaluations in routine public health practice. %M 24776527 %R 10.2196/jmir.3099 %U http://www.jmir.org/2014/4/e116/ %U https://doi.org/10.2196/jmir.3099 %U http://www.ncbi.nlm.nih.gov/pubmed/24776527 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 3 %N 2 %P e22 %T Cameras for Public Health Surveillance: A Methods Protocol for Crowdsourced Annotation of Point-of-Sale Photographs %A Ilakkuvan,Vinu %A Tacelosky,Michael %A Ivey,Keith C %A Pearson,Jennifer L %A Cantrell,Jennifer %A Vallone,Donna M %A Abrams,David B %A Kirchner,Thomas R %+ Department of Research and Evaluation, Legacy, 1724 Massachusetts Avenue NW, Washington, DC, 20036, United States, 1 2024545791, vilakkuvan@legacyforhealth.org %K image processing %K crowdsourcing %K annotation %K public health %K surveillance %D 2014 %7 09.04.2014 %9 Protocol %J JMIR Res Protoc %G English %X Background: Photographs are an effective way to collect detailed and objective information about the environment, particularly for public health surveillance. However, accurately and reliably annotating (ie, extracting information from) photographs remains difficult, a critical bottleneck inhibiting the use of photographs for systematic surveillance. The advent of distributed human computation (ie, crowdsourcing) platforms represents a veritable breakthrough, making it possible for the first time to accurately, quickly, and repeatedly annotate photos at relatively low cost. Objective: This paper describes a methods protocol, using photographs from point-of-sale surveillance studies in the field of tobacco control to demonstrate the development and testing of custom-built tools that can greatly enhance the quality of crowdsourced annotation. Methods: Enhancing the quality of crowdsourced photo annotation requires a number of approaches and tools. The crowdsourced photo annotation process is greatly simplified by decomposing the overall process into smaller tasks, which improves accuracy and speed and enables adaptive processing, in which irrelevant data is filtered out and more difficult targets receive increased scrutiny. Additionally, zoom tools enable users to see details within photographs and crop tools highlight where within an image a specific object of interest is found, generating a set of photographs that answer specific questions. Beyond such tools, optimizing the number of raters (ie, crowd size) for accuracy and reliability is an important facet of crowdsourced photo annotation. This can be determined in a systematic manner based on the difficulty of the task and the desired level of accuracy, using receiver operating characteristic (ROC) analyses. Usability tests of the zoom and crop tool suggest that these tools significantly improve annotation accuracy. The tests asked raters to extract data from photographs, not for the purposes of assessing the quality of that data, but rather to assess the usefulness of the tool. The proportion of individuals accurately identifying the presence of a specific advertisement was higher when provided with pictures of the product’s logo and an example of the ad, and even higher when also provided the zoom tool (χ22=155.7, P<.001). Similarly, when provided cropped images, a significantly greater proportion of respondents accurately identified the presence of cigarette product ads (χ21=75.14, P<.001), as well as reported being able to read prices (χ22=227.6, P<.001). Comparing the results of crowdsourced photo-only assessments to traditional field survey data, an excellent level of correspondence was found, with area under the ROC curves produced by sensitivity analyses averaging over 0.95, requiring on average 10 to 15 crowdsourced raters to achieve values of over 0.90. Results: Further testing and improvement of these tools and processes is currently underway. This includes conducting systematic evaluations that crowdsource photograph annotation and methodically assess the quality of raters’ work. Conclusions: Overall, the combination of crowdsourcing technologies with tiered data flow and tools that enhance annotation quality represents a breakthrough solution to the problem of photograph annotation, vastly expanding opportunities for the use of photographs rich in public health and other data on a scale previously unimaginable. %M 24717168 %R 10.2196/resprot.3277 %U http://www.researchprotocols.org/2014/2/e22/ %U https://doi.org/10.2196/resprot.3277 %U http://www.ncbi.nlm.nih.gov/pubmed/24717168 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 3 %N 1 %P e4 %T What Influences Patient Participation in an Online Forum for Weight Loss Surgery? A Qualitative Case Study %A Das,Anita %A Faxvaag,Arild %+ Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Medisinsk Teknisk Forskningssenter, Trondheim, 7491, Norway, 47 73551531, anita.das@ntnu.no %K obesity %K eHealth %K bariatric surgery %K online forum %K communication %K social support %D 2014 %7 06.02.2014 %9 Original Paper %J Interact J Med Res %G English %X Background: Many patients who undergo weight loss (bariatric) surgery seek information and social support in online discussion forums, but the vast amount of available information raises concerns about the impact of such information. A secure online discussion forum was developed and offered to bariatric surgery patients. The forum was moderated and allowed contact with peers and health care professionals. Objective: The purposes of this study were to explore how individuals undergoing bariatric surgery used the moderated discussion forum and to better understand what influenced their participation in the forum. Methods: The study was designed as an explorative case study. We conducted participant observation of the discussion forum over a time period of approximately six months. For further insight, we carried out in-depth semistructured interviews with seven patients who had access to the forum. We analyzed the material inductively, using content and thematic analysis. Results: The patients used the forum as an arena in which to interact with peers and providers, as well as to provide and achieve informational and social support. The analysis suggests that there are three major themes that influenced participation in the online discussion forum: (1) the participant’s motivation to seek information, advice, and guidance, (2) the need for social support and networking among peers, and (3) concerns regarding self-disclosure. Conclusions: The findings of this study imply that a moderated discussion forum for bariatric surgery patients has potential for use in a therapeutic context. The discussion forum fulfilled the informational and support needs of the bariatric surgery patients and was particularly useful for those who excluded themselves from the traditional program and experienced barriers to expressing their own needs. Even though our findings imply that the patients benefitted from using the forum regardless of their active or passive participation, restraining factors, such as considerations regarding self-disclosure, must be further investigated to prevent certain users from being precluded from participation. %M 24509408 %R 10.2196/ijmr.2847 %U http://www.i-jmr.org/2014/1/e4/ %U https://doi.org/10.2196/ijmr.2847 %U http://www.ncbi.nlm.nih.gov/pubmed/24509408 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 2 %N 2 %P e31 %T Aftershocks Associated With Impaired Health Caused by the Great East Japan Disaster Among Youth Across Japan: A National Cross-Sectional Survey %A Sugimoto,Takashi %A Shinozaki,Tomohiro %A Miyamoto,Yuki %+ Graduate School of Medicine, Department of Psychiatric Nursing, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-0033, Japan, 81 3 5841 3522, sugimotot-tky@umin.ac.jp %K earthquakes %K health communication %K Internet %K nuclear power plants %K risk management %D 2013 %7 20.12.2013 %9 Original Paper %J Interact J Med Res %G English %X Background: The Great East Japan earthquake, subsequent tsunamis and the Fukushima nuclear incident had a tremendous impact on Japanese society. Although small-scale surveys have been conducted in highly affected areas, few have elucidated the disaster’s effect on health from national perspective, which is necessary to prepare national policy and response. Objective: The aim of the present study was to describe prefecture-level health status and investigate associations with number of aftershocks, seismic intensity, a closer geographical location to the Fukushima Nuclear Power Plant, or higher reported radiation dose in each prefecture even after adjusting for individual socioeconomic factors, by utilizing individual-level data acquired from a national cross-sectional Internet survey as well as officially reported prefecture-level data. Methods: A Japanese government research institute obtained 12,000 participants by quota sampling and 7335 participants were eligible for the analysis in an age range between 17 and 27 years old. We calculated the percentage of people with decreased subjective health in each prefecture after the earthquake. Variability introduced by a small sample size for some prefectures was smoothed using empirical Bayes estimation with a random-intercept logistic model, with and without demographic factors. Multilevel logistic regression was used to calculate adjusted odds ratios (ORs) for change of subjective health associated with prefecture-level and individual-level factors. Results: Adjusted empirical Bayes estimates were higher for respondents commuting in the northeast region (Iwate 14%, Miyagi 19%, and Fukushima 28%), which faces the Pacific Ocean, while the values for Akita (10%) and Yamagata (8%) prefectures, which do not face the Pacific Ocean, were lower than those of Tokyo (12%). The values from the central to the western region were clearly lower. The number of aftershocks was coherently associated with decreased health (OR 1.05 per 100 times, 95% CI 1.04-1.06; P<.001) even after adjusting for covariates (OR 1.02 per 100 times, 95% CI 1.00-1.05; 1.32 per 1000 times, 95% CI 1.03-1.71; P=.049). In contrast, seismic intensity of the initial earthquake (OR 0.87, 95% CI 0.65-1.17; P=.36), radiation dose (OR 1.16, 95% CI 0.82-1.64; P=.41), and distance from the Fukushima Nuclear Power Plant (OR 1.00, 95% CI 0.99-1.00; P=.66) were not. Change in job condition (OR 2.05, 95% CI 1.72-2.45; P<.001), female (OR 1.43, 95% CI 1.19-1.69; P<.001), higher age (OR 1.06 per year, 95% CI 1.02-1.11; P=.005), and duration of evacuation longer than 4 weeks (OR 1.44, 95% CI 1.06-1.97; P=.02) seemed to decrease perceived health status. Conclusions: We found nationwide differences that show decreased health status because of the Great East Japan disaster according to prefecture. The number of aftershocks, change in work conditions, being female, a higher age, and duration of the evacuation were risk factors for the population after the major earthquake, tsunamis, and nuclear incident. %M 24362519 %R 10.2196/ijmr.2585 %U http://www.i-jmr.org/2013/2/e31/ %U https://doi.org/10.2196/ijmr.2585 %U http://www.ncbi.nlm.nih.gov/pubmed/24362519 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 9 %P e202 %T A Web-Based Interactive Diabetes Registry for Health Care Management and Planning in Saudi Arabia %A Al-Rubeaan,Khalid A %A Youssef,Amira M %A Subhani,Shazia N %A Ahmad,Najlaa A %A Al-Sharqawi,Ahmad H %A Ibrahim,Heba M %+ Strategic Center for Diabetes Research, University Diabetes Centre, King Saud University, PO Box 18397, Riyadh, 11415, Saudi Arabia, 966 11 282 5402, krubean@ksu.edu.sa %K diabetes mellitus %K registries %K geographic information systems %K medical records systems, computerized %K health planning %K research report %K data bank, factual %K epidemiology %D 2013 %7 11.09.2013 %9 Viewpoint %J J Med Internet Res %G English %X Background: Worldwide, eHealth is a rapidly growing technology. It provides good quality health services at lower cost and increased availability. Diabetes has reached an epidemic stage in Saudi Arabia and has a medical and economic impact at a countrywide level. Data are greatly needed to better understand and plan to prevent and manage this medical problem. Objective: The Saudi National Diabetes Registry (SNDR) is an electronic medical file supported by clinical, investigational, and management data. It functions as a monitoring tool for medical, social, and cultural bases for primary and secondary prevention programs. Economic impact, in the form of direct or indirect cost, is part of the registry’s scope. The registry’s geographic information system (GIS) produces a variety of maps for diabetes and associated diseases. In addition to availability and distribution of health facilities in the Kingdom, GIS data provide health planners with the necessary information to make informed decisions. The electronic data bank serves as a research tool to help researchers for both prospective and retrospective studies. Methods: A Web-based interactive GIS system was designed to serve as an electronic medical file for diabetic patients retrieving data from medical files by trained registrars. Data was audited and cleaned before it was archived in the electronic filing system. It was then used to produce epidemiologic, economic, and geographic reports. A total of 84,942 patients were registered from 2000 to 2012, growing by 10% annually. Results: The SNDR reporting system for epidemiology data gives better understanding of the disease pattern, types, and gender characteristics. Part of the reporting system is to assess quality of health care using different parameters, such as HbA1c, that gives an impression of good diabetes control for each institute. Economic reports give accurate cost estimation of different services given to diabetic patients, such as the annual insulin cost per patient for type 1, type 2, and gestational diabetes, which are 1155 SR (US $308), 1406 SR (US $375), and 1002 SR (US $267), respectively. Of this, 72.02% of the total insulin cost is spent on type 2 patients and 55.39% is in the form of premixed insulin. The SNDR can provide an accurate assessment of the services provided for research purposes. For example, only 27.00% of registered patients had an ophthalmic examination and only 71.10% of patients with proliferative retinopathy had laser therapy. Conclusions: The SNDR is an effective electronic medical file that can provide epidemiologic, economic, and geographic reports that can be used for disease management and health care planning. It is a useful tool for research and disease health care quality monitoring. %M 24025198 %R 10.2196/jmir.2722 %U http://www.jmir.org/2013/9/e202/ %U https://doi.org/10.2196/jmir.2722 %U http://www.ncbi.nlm.nih.gov/pubmed/24025198 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 2 %N 1 %P e9 %T Developing Electronic Cooperation Tools: A Case From Norwegian Health Care %A Larsen,Eli %A Mydske,Per Kristen %+ Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Sykehusvn. 23, Tromsø, 9019, Norway, 47 90778661, eli.larsen@telemed.no %K health communication %K public policy %K communication barriers %D 2013 %7 19.06.2013 %9 Original Paper %J Interact J Med Res %G English %X Background: Many countries aim to create electronic cooperational tools in health care, but the progress is rather slow. Objective: The study aimed to uncover how the authoritys’ financing policies influence the development of electronic cooperational tools within public health care. Methods: An interpretative approach was used in this study. We performed 30 semistructured interviews with vendors, policy makers, and public authorities. Additionally, we conducted an extensive documentation study and participated in 18 workshops concerning information and communication technology (ICT) in Norwegian health care. Results: We found that the interorganizational communication in sectors like health care, that have undergone an independent development of their internal information infrastructure would find it difficult to create electronic services that interconnect the organizations because such connections would affect all interconnected organizations within the heterogenic structure. The organizations would, to a large extent, depend on new functionality in existing information systems. Electronic patient records play a central role in all parts of the health care sector and therefore dependence is established to the information systems and theirs vendors. The Norwegian government authorities, which run more than 80% of the Norwegian health care, have not taken extraordinary steps to compensate for this dependency–the government's political philosophy is that each health care institution should pay for further electronic patient record development. However, cooperational tools are complex due to the number of players involved and the way they are intertwined with the overall workflow. The customers are not able to buy new functionalities on the drawing table, while the electronic patient record vendors are not willing to take the economic risk in developing cooperational tools. Thus, the market mechanisms in the domain are challenged. We also found that public projects that were only financed for the first steps of project management could partially explain why many initiatives did not get past the initial planning and specification stages, but were stopped before further development could be made. Vendors were often unwilling to provide further own contribution without guaranteed return. Conclusions: We propose that the authorities take a coordinating role and provide financial help for development of electronic cooperational tools for health because the regular market mechanisms are insufficient to push these developments to the market. It is, however, critical that the role of users be considered, and for users to decide which developments should go forward. %M 23782708 %R 10.2196/ijmr.2346 %U http://www.i-jmr.org/2013/1/e9/ %U https://doi.org/10.2196/ijmr.2346 %U http://www.ncbi.nlm.nih.gov/pubmed/23782708 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 2 %N 1 %P e10 %T Growing Concerns With the Flow of Misinformation From Electronic Books %A Takahashi,Kenzo %A Kanda,Hideyuki %A Mizushima,Shunsaku %+ Department of Epidemiology and Public Health, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan, 81 45 787 2610, kt_intl_@ja2.so-net.ne.jp %K misinformation %K e-book %K ethical guideline %K anti-vaccinists %K atopy business %K wellness maintenance %D 2013 %7 24.05.2013 %9 Viewpoint %J Interact J Med Res %G English %X In 2012, several kinds of electronic books (e-books) became available in Japan. Since several major book retailers launched e-book businesses, it is expected that e-books will become a popular source of information in the country. However, we are concerned that e-books may also be a source of misinformation. In examining 24 available materials published by anti-vaccinists, "atopy businesses", and "wellness maintenance" authors, each was found to contain inaccuracies or misinformation. Thus far, such information is only available in printed books. If these books are scanned and circulated, or published in e-book format, this misinformation may circulate rapidly as e-book devices are becoming popular, and, consequently, harm people’s health. We think that it is important for the government to formulate ethical guidelines for the publishing e-books with due consideration to freedom of expression. %M 23709125 %R 10.2196/ijmr.2541 %U http://www.i-jmr.org/2013/1/e10/ %U https://doi.org/10.2196/ijmr.2541 %U http://www.ncbi.nlm.nih.gov/pubmed/23709125 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 2 %N 1 %P e6 %T Identifying Measures Used for Assessing Quality of YouTube Videos with Patient Health Information: A Review of Current Literature %A Gabarron,Elia %A Fernandez-Luque,Luis %A Armayones,Manuel %A Lau,Annie YS %+ NST-Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, P.O. Box 35, Tromsø, 9038, Norway, 47 07766, elia.gabarron@telemed.no %K YouTube %K patient education %K Internet %K health education %K quality of information %D 2013 %7 28.02.2013 %9 Original Paper %J Interact J Med Res %G English %X Background: Recent publications on YouTube have advocated its potential for patient education. However, a reliable description of what could be considered quality information for patient education on YouTube is missing. Objective: To identify topics associated with the concept of quality information for patient education on YouTube in the scientific literature. Methods: A literature review was performed in MEDLINE, ISI Web of Knowledge, Scopus, and PsychINFO. Abstract selection was first conducted by two independent reviewers; discrepancies were discussed in a second abstract review with two additional independent reviewers. Full text of selected papers were analyzed looking for concepts, definitions, and topics used by its authors that focused on the quality of information on YouTube for patient education. Results: In total, 456 abstracts were extracted and 13 papers meeting eligibility criteria were analyzed. Concepts identified related to quality of information for patient education are categorized as expert-driven, popularity-driven, or heuristic-driven measures. These include (in descending order): (1) quality of content in 10/13 (77%), (2) view count in 9/13 (69%), (3) health professional opinion in 8/13 (62%), (4) adequate length or duration in 6/13 (46%), (5) public ratings in 5/13 (39%), (6) adequate title, tags, and description in 5/13 (39%), (7) good description or a comprehensive narrative in 4/13 (31%), (8) evidence-based practices included in video in 4/13 (31%), (9) suitability as a teaching tool in 4/13 (31%), (10) technical quality in 4/13 (31%), (11) credentials provided in video in 4/13 (31%), (12) enough amount of content to identify its objective in 3/13 (23%), and (13) viewership share in 2/13 (15%). Conclusions: Our review confirms that the current topics linked to quality of information for patient education on YouTube are unclear and not standardized. Although expert-driven, popularity-driven, or heuristic-driven measures are used as proxies to estimate the quality of video information, caution should be applied when using YouTube for health promotion and patient educational material. %M 23612432 %R 10.2196/ijmr.2465 %U http://www.i-jmr.org/2013/1/e6/ %U https://doi.org/10.2196/ijmr.2465 %U http://www.ncbi.nlm.nih.gov/pubmed/23612432 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 2 %N 1 %P e2 %T Prevalence of Insomnia Among Residents of Tokyo and Osaka After the Great East Japan Earthquake: A Prospective Study %A Sugiura,Hiroaki %A Akahane,Manabu %A Ohkusa,Yasushi %A Okabe,Nobuhiko %A Sano,Tomomi %A Jojima,Noriko %A Bando,Harumi %A Imamura,Tomoaki %+ Health Management and Policy, Department of Public Health, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, 634-8521, Japan, 81 744 22 3051 ext 2224, tomomarie@smn.enjoy.ne.jp %K insomnia %K Web-based survey %K population surveillance %K disaster %K nuclear accidents %K earthquakes %D 2013 %7 18.01.2013 %9 Original Paper %J Interact J Med Res %G English %X Background: The Great East Japan Earthquake occurred on March 11, 2011. Tokyo and Osaka, which are located 375 km and 750 km, respectively, from the epicenter, experienced tremors of 5.0 lower and 3.0 seismic intensity on the Japan Meteorological Agency scale. The Great East Japan Earthquake was the fourth largest earthquake in the world and was accompanied by a radioactive leak at a nuclear power plant and a tsunami. In the aftermath of a disaster, some affected individuals presented to mental health facilities with acute stress disorder (ASD) and/or post-traumatic stress disorder (PTSD). However, few studies have addressed mental stress problems other than ASD or PTSD among the general public immediately after a disaster. Further, the effects of such a disaster on residents living at considerable distances from the most severely affected area have not been examined. Objective: This study aimed to prospectively analyze the effect of a major earthquake on the prevalence of insomnia among residents of Tokyo and Osaka. Methods: A prospective online questionnaire study was conducted in Tokyo and Osaka from January 20 to April 30, 2011. An Internet-based questionnaire, intended to be completed daily for a period of 101 days, was used to collect the data. All of the study participants lived in Tokyo or Osaka and were Consumers’ Co-operative Union (CO-OP) members who used an Internet-based food-ordering system. The presence or absence of insomnia was determined before and after the earthquake. These data were compared after stratification for the region and participants’ age. Multivariate analyses were conducted using logistic regression and a generalized estimating equation. This study was conducted with the assistance of the Japanese CO-OP. Results: The prevalence of insomnia among adults and minors in Tokyo and adults in Osaka increased significantly after the earthquake. No such increase was observed among minors in Osaka. The overall adjusted odds ratios for the risk of insomnia post-earthquake versus pre-earthquake were 1.998 (95% CI 1.571–2.542) for Tokyo, 1.558 (95% CI 1.106–2.196) for Osaka, and 1.842 (95% CI,1.514–2.242) for both areas combined. Conclusions: The prevalence of insomnia increased even in regions that were at a considerable distance from the epicenter. Both adults and minors in Tokyo, where the seismic intensity was greater, experienced stress after the earthquake. In Osaka, where the earthquake impact was milder, disturbing video images may have exacerbated insomnia among adults. %M 23612152 %R 10.2196/ijmr.2485 %U http://www.i-jmr.org/2013/1/e2/ %U https://doi.org/10.2196/ijmr.2485 %U http://www.ncbi.nlm.nih.gov/pubmed/23612152 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 1 %N 2 %P e20 %T Issues Regarding the Implementation of eHealth: Preparing for Future Influenza Pandemics %A Li,Junhua %A Seale,Holly %A Ray,Pradeep %A Rawlinson,William %A Lewis,Lundy %A MacIntyre,C. Raina %+ Asia-Pacific Ubiquitous Healthcare Research Centre, The University of New South Wales, APuHC, Room 1039, 1st floor, west wing, Quadrangle Building, kensington Campus, University of New South Wales, Sydney, , Australia, 61 (2) 9931 9308, junhua.li.syd@gmail.com %K eHealth %K influenza pandemic %K preparedness assessment %K case study %D 2012 %7 06.12.2012 %9 Original Paper %J Interact J Med Res %G English %X Background: eHealth is a tool that may be used to facilitate responses to influenza pandemics. Prior to implementation of eHealth in the hospital setting, assessment of the organizational preparedness is an important step in the planning process. Including this step may increase the chance of implementation success. Objective: To identify the preparedness issues in relation to implementation of eHealth for future influenza pandemics. Methods: One hospital was selected in Australia for this study. We conducted 12 individual interviews to gather a rich data set in relation to eHealth preparedness in the context of the 2009 influenza A (H1N1) pandemic at this major teaching hospital. These participants’ views were analyzed according to five main themes: (1) challenges in present practices or circumstances for pandemic responses, which indicates a need for change, (2) healthcare providers’ exposure to eHealth, (3) organizational technological capacity to support an IT innovation for medical practices, (4) resource preparedness, and (5) socio-cultural issues in association with eHealth implementation in response to a pandemic. Results: This article reports a subset of the issues identified during the case study. These issues include, for example, poor sharing of patient health records, poor protection of patient privacy, clinicians’ concerns about IT reliability and dissatisfaction with the software in use, clinicians’ concerns about IT’s impact on professional autonomy versus having inefficient IT support, and inefficient communication across departments in the form of consultation. Conclusions: Based on discussions with the participants and interpretation of their responses, we assessed the hospital’s preparedness status and also identified areas of deficiency. Accordingly, we suggest possible solutions for the areas in need of improvement to facilitate eHealth implementation’s success. The study results will also provide policymakers at national, state and local levels with insights to refine relevant public health policies for the planning and management of pandemics from the eHealth perspective. %M 23611788 %R 10.2196/ijmr.2357 %U http://www.i-jmr.org/2012/2/e20/ %U https://doi.org/10.2196/ijmr.2357 %U http://www.ncbi.nlm.nih.gov/pubmed/23611788 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 1 %N 2 %P e18 %T Use of a Web Portal for Support and Research After a Disaster: Opportunities and Lessons Learned %A Marres,Geertruid MH %A Leenen,Luke PH %A van der Slikke,Johannes W %A Vermetten,Eric %+ University Medical Centre Utecht, Central Military Hospital, Major Incident Hospital, Heidelberglaan 100, Utrecht, 3508 GA, Netherlands, 31 88 7559882, gmarres@hotmail.com %K Disaster medicine %K Stress Disorders %K Post-Traumatic %K Internet %K mental health %K health surveys %K stress, psychological %K Online Systems %K Self-Help groups %D 2012 %7 21.11.2012 %9 Original Paper %J Interact J Med Res %G English %X Background: In this report we describe the development and use of a web portal in the aftermath of the 2004 tsunami. This large scale disaster confronted many displaced people with death, despair and need for information and support. Awareness and insight in the emotional impact of disasters can provide opportunities for surveillance and early treatment. Moreover, online support systems can contribute to community building, empowerment of victims and resilience. Objective: We evaluate the development and use of a multilingual web portal that combined a platform for information, emotional support, self assessment and referral with research opportunities. The rapid development, use, advantages, difficulties and learning points are discussed. Methods: A multidisciplinary working group from the University Medical Centre Utrecht, the Major Incident Hospital and the Central Military Hospital developed a web portal for tsunami victims. The webportal combined: (1) a forum aimed at community building, (2) self assessment tools that in the same time function as a reseach survey, (3) e-consultation, and (4) an information portal. Results: Within 3 weeks after the tsunami, the working group launched an open, online service (www.TISEI.org. Tsunami Intrenational Survey on Emotional Impact) to foster community) support in the aftermath of the disaster. It combined four functionalities that were earlier previously only used separately. The portal had over 36.800 unique visitors in the first two years. At least 31% (144/464) percent of the Dutch surviving victims could be reached for a survey through the site. The TISEI-environment was available in 15 languages and visitors came from all over the world. Ninety-five percent of all visitors came from Europe or the United States. Subsequent to immediate disaster support, the web portal also served as a memorial archive for anniversary meetings and follow-up incentives. Difficulties we experienced were lack of funding, time pressure, victim-anonymisation, international collaboration and long term maintenance. Conclusions: A multilingual website with combined modalities for emotional care and research after a natural disaster proved feasible. Web based services like www.TISEI.org in the aftermath of mass disasters can help community building and deliver low level, patient centred and easily accessible information and care. A multilingual website with combined modalities for emotional care and research after a natural disaster proved feasible. Growing Internet penetration world wide and especially the rapid expansion and influence of online communities enables delivery of care and perform research with the internetInternet as a platform. The unpredictable nature of disaster does put time pressure on the development of online solutions and influenced the yield of our site. This highlights the necessity of developing methods and (inter) national collaborations in advance, secure funding, and learn from earlier initiatives. %M 23612349 %R 10.2196/ijmr.1588 %U http://www.i-jmr.org/2012/2/e18/ %U https://doi.org/10.2196/ijmr.1588 %U http://www.ncbi.nlm.nih.gov/pubmed/23612349 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 1 %N 1 %P e1 %T Can Consumers Trust Web-Based Information About Celiac Disease? Accuracy, Comprehensiveness, Transparency, and Readability of Information on the Internet %A McNally,Shawna L %A Donohue,Michael C %A Newton,Kimberly P %A Ogletree,Sandra P %A Conner,Kristen K %A Ingegneri,Sarah E %A Kagnoff,Martin F %+ Wm. K. Warren Medical Research Center for Celiac Disease, Department of Medicine, University of California, San Diego, MC 0623, Room 412 Medical Teaching Facililty, 9500 Gilman Drive, La Jolla, CA, 92093-0623, United States, 1 858 534 4622, mkagnoff@ucsd.edu %K Celiac disease %K health information %K website accuracy %K website comprehensiveness %K website transparency %K website quality %D 2012 %7 04.04.2012 %9 Original Paper %J Interact J Med Res %G English %X Background: Celiac disease is an autoimmune disease that affects approximately 1% of the US population. Disease is characterized by damage to the small intestinal lining and malabsorption of nutrients. Celiac disease is activated in genetically susceptible individuals by dietary exposure to gluten in wheat and gluten-like proteins in rye and barley. Symptoms are diverse and include gastrointestinal and extraintestinal manifestations. Treatment requires strict adherence to a gluten-free diet. The Internet is a major source of health information about celiac disease. Nonetheless, information about celiac disease that is available on various websites often is questioned by patients and other health care professionals regarding its reliability and content. Objectives: To determine the accuracy, comprehensiveness, transparency, and readability of information on 100 of the most widely accessed websites that provide information on celiac disease. Methods: Using the search term celiac disease, we analyzed 100 of the top English-language websites published by academic, commercial, nonprofit, and other professional (nonacademic) sources for accuracy, comprehensiveness, transparency, and reading grade level. Each site was assessed independently by 3 reviewers. Website accuracy and comprehensiveness were probed independently using a set of objective core information about celiac disease. We used 19 general criteria to assess website transparency. Website readability was determined by the Flesch-Kincaid reading grade level. Results for each parameter were analyzed independently. In addition, we weighted and combined parameters to generate an overall score, termed website quality. Results: We included 98 websites in the final analysis. Of these, 47 (48%) provided specific information about celiac disease that was less than 95% accurate (ie, the predetermined cut-off considered a minimum acceptable level of accuracy). Independent of whether the information posted was accurate, 51 of 98 (52%) websites contained less than 50% of the core celiac disease information that was considered important for inclusion on websites that provide general information about celiac disease. Academic websites were significantly less transparent (P = .005) than commercial websites in attributing authorship, timeliness of information, sources of information, and other important disclosures. The type of website publisher did not predict website accuracy, comprehensiveness, or overall website quality. Only 4 of 98 (4%) websites achieved an overall quality score of 80 or above, which a priori was set as the minimum score for a website to be judged trustworthy and reliable. Conclusions: The information on many websites addressing celiac disease was not sufficiently accurate, comprehensive, and transparent, or presented at an appropriate reading grade level, to be considered sufficiently trustworthy and reliable for patients, health care providers, celiac disease support groups, and the general public. This has the potential to adversely affect decision making about important aspects of celiac disease, including its appropriate and proper diagnosis, treatment, and management. %M 23611901 %R 10.2196/ijmr.2010 %U http://www.i-jmr.org/2012/1/e1/ %U https://doi.org/10.2196/ijmr.2010 %U http://www.ncbi.nlm.nih.gov/pubmed/23611901