%0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e15815 %T Reliability, Feasibility, and Patient Acceptance of an Electronic Version of a Multidimensional Health Assessment Questionnaire for Routine Rheumatology Care: Validation and Patient Preference Study %A Pincus,Theodore %A Castrejon,Isabel %A Riad,Mariam %A Obreja,Elena %A Lewis,Candice %A Krogh,Niels Steen %+ Rush University Medical Center, 1611 West Harrison, Suite 510, Chicago, IL, United States, 1 3129428268, tedpincus@gmail.com %K patient reported outcomes %K health status measures %K electronic version %K rapid3 %K mdhaq %D 2020 %7 27.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: A multidimensional health assessment questionnaire (MDHAQ) that was developed primarily for routine rheumatology care has advanced clinical research concerning disease burden, disability, and mortality in rheumatic diseases. Routine Assessment of Patient Index Data 3 (RAPID3), an index within the MDHAQ, is the most widely used index to assess rheumatoid arthritis (RA) in clinical care in the United States, and it recognizes clinical status changes in all studied rheumatic diseases. MDHAQ physical function scores are far more significant in the prognosis of premature RA mortality than laboratory or imaging data. However, electronic medical records (EMRs) generally do not include patient questionnaires. An electronic MDHAQ (eMDHAQ), linked by fast healthcare interoperability resources (FIHR) to an EMR, can facilitate clinical and research advances. Objective: This study analyzed the reliability, feasibility, and patient acceptance of an eMDHAQ. Methods: Since 2006, all Rush University Medical Center rheumatology patients with all diagnoses have been asked to complete a paper MDHAQ at each routine care encounter. In April 2019, patients were invited to complete an eMDHAQ at the conclusion of the encounter. Analyses were conducted to determine the reliability of eMDHAQ versus paper MDHAQ scores, arithmetically and by intraclass correlation coefficient (ICC). The feasibility of the eMDHAQ was analyzed based on the time for patient completion. The patient preference for the electronic or paper version was analyzed through a patient paper questionnaire. Results: The 98 study patients were a typical routine rheumatology patient group. Seven paper versus eMDHAQ scores were within 2%, differences neither clinically nor statistically significant. ICCs of 0.86-0.98 also indicated good to excellent reliability. Mean eMDHAQ completion time was a feasible 8.2 minutes. The eMDHAQ was preferred by 72% of patients; preferences were similar according to age and educational level. Conclusions: The results on a paper MDHAQ versus eMDHAQ were similar. Most patients preferred an eMDHAQ. %M 32459182 %R 10.2196/15815 %U http://formative.jmir.org/2020/5/e15815/ %U https://doi.org/10.2196/15815 %U http://www.ncbi.nlm.nih.gov/pubmed/32459182 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 3 %P e15158 %T Improving Quality of Care in Rheumatoid Arthritis Through Mobile Patient-Reported Outcome Measurement: Focus Group Study %A Desai,Sonali %A Stevens,Emma %A Emani,Srinivas %A Meyers,Peter %A Iversen,Maura %A Solomon,Daniel H %+ Brigham & Women's Hospital, 60 Fenwood Road, Hale Building for Transformative Medicine, Boston, MA, Rheumatology, 3rd fl, United States, 1 6177326758, sdesai5@bwh.harvard.edu %K quality improvement %K rheumatoid arthritis %D 2020 %7 27.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient-reported outcomes (PROs) for chronic disease management can be integrated into the routine workflow by leveraging mobile technology. Objective: The objective of our study was to describe the process of our quality improvement (QI) efforts using tablets for PRO collection in a busy, academic rheumatology practice to support a treat-to-target (TTT) approach for rheumatoid arthritis (RA) management. Methods: Our QI team designed a process for routine collection of PROs for RA patients at the Arthritis Center, employing information technology and an electronic medical record (EMR) system. Patients received a tablet at the clinic check-in desk to complete the Routine Assessment of Patient Index Data 3 (RAPID3) survey, a validated RA PRO. RAPID3 scores were uploaded to the EMR in real time and available for use in shared decision making during routine office visits. Weekly data were collected on RAPID3 completion rates and shared with front desk staff and medical assistants to drive improvement. Patients in our patient family advisory council and focus groups provided informal feedback on the process. Results: From May 1, 2017, to January 31, 2019, a total of 4233 RAPID3 surveys were completed by 1691 patients. The mean age of patients was 63 (SD 14) years; 84.00% (1420/1691) of the patients were female, and 83.00% (1403/1691) of the patients were white. The rates of RAPID3 completion increased from 14.3% (58/405) in May 2017 to 68.00% (254/376) in September 2017 and were sustained over time through January 2019. Informal feedback from patients was positive and negative, relating to the usability of the tablet and the way rheumatologists used and explained the RAPID3 data in shared decision making during the office visit. Conclusions: We designed a sustainable and reliable process for collecting PROs from patients with RA in the waiting room and integrated these data through the EMR during office visits. %R 10.2196/15158 %U http://formative.jmir.org/2020/3/e15158/ %U https://doi.org/10.2196/15158 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e17507 %T Toward Earlier Diagnosis Using Combined eHealth Tools in Rheumatology: The Joint Pain Assessment Scoring Tool (JPAST) Project %A Knitza,Johannes %A Knevel,Rachel %A Raza,Karim %A Bruce,Tor %A Eimer,Ekaterina %A Gehring,Isabel %A Mathsson-Alm,Linda %A Poorafshar,Maryam %A Hueber,Axel J %A Schett,Georg %A Johannesson,Martina %A Catrina,Anca %A Klareskog,Lars %A , %+ Department of Internal Medicine 3 – Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg, University Hospital Erlangen, Ulmenweg 18, Erlangen, 91054, Germany, 49 91318532093, johannes.knitza@uk-erlangen.de %K rheumatology %K eHealth %K mHealth %K symptom-checkers %K apps %D 2020 %7 15.5.2020 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Outcomes of patients with inflammatory rheumatic diseases have significantly improved over the last three decades, mainly due to therapeutic innovations, more timely treatment, and a recognition of the need to monitor response to treatment and to titrate treatments accordingly. Diagnostic delay remains a major challenge for all stakeholders. The combination of electronic health (eHealth) and serologic and genetic markers holds great promise to improve the current management of patients with inflammatory rheumatic diseases by speeding up access to appropriate care. The Joint Pain Assessment Scoring Tool (JPAST) project, funded by the European Union (EU) European Institute of Innovation and Technology (EIT) Health program, is a unique European project aiming to enable and accelerate personalized precision medicine for early treatment in rheumatology, ultimately also enabling prevention. The aim of the project is to facilitate these goals while at the same time, reducing cost for society and patients. %M 32348258 %R 10.2196/17507 %U https://mhealth.jmir.org/2020/5/e17507 %U https://doi.org/10.2196/17507 %U http://www.ncbi.nlm.nih.gov/pubmed/32348258 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e16763 %T Googling Allergy in Ireland: Content Analysis %A King,Catherine %A Judge,Ciaran %A Byrne,Aideen %A Conlon,Niall %+ Department of Clinical and Laboratory Immunology, St. James's Hospital, James's Street, Dublin 8, Ireland, 353 1 410 3000, cathmarionking@gmail.com %K allergy %K food allergy %K food intolerance %K technology %K Ireland %K immunology %D 2020 %7 13.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet search engines are increasingly being utilized as the first port of call for medical information by the public. The prevalence of allergies in developed countries has risen steadily over time. There exists significant variability in the quality of health-related information available on the web. Inaccurately diagnosed and mismanaged allergic disease has major downstream effects on patients, general practitioners, and regional allergy services. Objective: This study aimed to verify whether Ireland has a relatively high rate of web-based allergy-related searches, to establish the proportion of medically accurate web pages encountered by the public, and to compare current search results localized to Dublin, Ireland with urban centers elsewhere. Methods: Google Trends was used to evaluate regional interest of allergy-related search terms over a 10-year period using terms “allergy,” “allergy test,” “food allergy,” and “food intolerance.” These terms were then inputted into Google search, localizing them to cities in Ireland, the United Kingdom, and the United States. Output for each search was reviewed by two independent clinicians and deemed rational or nonevidence based, as per current best practice guidelines. Searches localized to Dublin were initially completed in 2015 and repeated in 2019 to assess for changes in the quality of search results over time. Results: Ireland has a persistently high demand for web-based information relating to allergy and ranks first worldwide for “allergy test,” second for “food allergy” and “food intolerance,” and seventh for “allergy” over the specified 10-year timeframe. Results for each of the four subsearches in Dublin (2015) showed that over 60% of websites promoted nonevidence-based diagnostics. A marginal improvement in scientifically robust information was seen in 2019, but results for “allergy test” and “food intolerance” continued to promote alternative testing 57% (8/14) of the time. This strongly contrasted with results localized to Southampton and Rochester, where academic and hospital-affiliated web pages predominantly featured. Government-funded Department of Health websites did not feature in the top five results for Dublin searches “allergy testing,” “food allergy,” or “food intolerance” in either 2015 or 2019. Conclusions: The Irish public demonstrates a keen interest in seeking allergy-related information on the web. The proportion of evidence-based websites encountered by the Irish public is considerably lower than that encountered by patients in other urban centers. Factors contributing to this are the lack of a specialist register for allergy in Ireland, inadequate funding for allergy centers currently in operation, and insufficient promotion by the health service of their web-based health database, which contains useful patient-oriented information on allergy. Increased funding of clinical allergology services will more meaningfully impact the health of patients if there is a parallel investment by the health service in information and communication technology consultancy to amplify their presence on the web. %M 32401220 %R 10.2196/16763 %U https://www.jmir.org/2020/5/e16763 %U https://doi.org/10.2196/16763 %U http://www.ncbi.nlm.nih.gov/pubmed/32401220 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 9 %N 2 %P e17863 %T Health-Related Effects of Home Nebulization With Glycopyrronium on Difficult-to-Treat Asthma: Post-Hoc Analyses of an Observational Study %A Talwar,Deepak %A Bendre,Salil %+ Department of Pulmonology and Sleep Medicine, Metro Centre for Respiratory Diseases, 94, Noida Road, D Block, Sector 11, Uttar Pradesh, Noida, 201301, India, 91 9899050000, hraastudy@gmail.com %K difficult-to-treat asthma %K exacerbation %K glycopyrronium %K home nebulization %K uncontrolled asthma %K vibrating mesh nebulizer %D 2020 %7 29.4.2020 %9 Original Paper %J Interact J Med Res %G English %X Background: Bronchial asthma remains a clinical enigma with poorly controlled symptoms or exacerbations despite regular use of inhaled corticosteroids. Home nebulization offers a simplified solution for the delivery of rescue and maintenance bronchodilators, which is especially true for patients with frequent exacerbations during management of uncontrolled or difficult-to-treat asthma. Objective: We aimed to assess the clinical impact and outcomes associated with home nebulization—delivered long-acting bronchodilators for uncontrolled or difficult-to-treat asthma. Methods: This observational, concurrent study was conducted with 60 patients at 2 centers during November 2018. Statistical analyses for prebronchodilator forced expiratory volume in one second (FEV1) and Global Initiative for Asthma (GINA) asthma control score in patients on long-acting bronchodilators and corticosteroids were conducted, with two-tailed P values <.05 considered statistically significant. Results: Per protocol analyses (53/60) for consecutive cases receiving home nebulization with long-acting bronchodilators and corticosteroids were conducted. The baseline demographics included a male-to-female ratio of 30:23 and mean values of the following: age, 60.3 years (SD 11.8 years); weight, 64 kg (SD 16.8 kg); FEV1, 43% (SD 16%); GINA asthma control score, 3.0 points (SD 0.8 points); serum eosinophil level, 4% (SD 3%); fractional exhaled nitric oxide (FeNO), 12.1 ppb (SD 6 ppb). Of the patients, 100% (53/53) had uncontrolled symptoms, 69.8% (37/53) had prior exacerbations, 100% (53/53) used formoterol/budesonide, and 75.5% (40/53) used glycopyrronium. The per protocol group (n=53) had significantly improved mean prebronchodilator FEV1 (23.7%, SD 29.8%; 0.46 L, SD 0.58 L; P<.001) and GINA asthma control score (2.1 points, SD 0.8 points, P<.001). At baseline, patients (n=40) receiving glycopyrronium/formoterol/budesonide (25/20/500 mcg) nebulization admixture had the following mean values: prebronchodilator FEV1, 38% (SD 15%); GINA asthma control score, 3.0 points (SD 0.8 points); reversibility, 12% (SD 6%); peripheral eosinophil level, 4% (SD 3%); FeNO, 12 ppb (SD 5.7 ppb). In the post hoc analyses, these patients had significantly improved mean prebronchodilator FEV1 of 27.7% (SD 26.2%; 0.54 L, SD 0.51 L; P<.001) at 8 weeks compared with baseline. At baseline, patients (n=13) receiving formoterol/budesonide (20/500 mcg) nebulization had the following mean values: FEV1, 55% (SD 12%); GINA asthma control score, 3.0 points (SD 1.2 points); reversibility, 14% (SD 7%); serum eosinophil level, 4% (SD 3%); FeNO, 13.3 ppb (SD 6.8 ppb). In the post hoc analyses, these patients showed a significant improvement in prebronchodilator FEV1 of 11.2% (SD 13.1%; 0.22 L, SD 0.25 L; P<.001) from baseline. Breathlessness of mild to moderate intensity was reported by 10 cases (10/53, 18.9%), with no other treatment-emergent adverse events or serious adverse events. Conclusions: Home nebulization remains a viable option for symptomatic difficult-to-treat asthma cases with frequent use of rescue medications. Glycopyrronium as add-on therapy offers a synergistic response in patients on corticosteroids with difficult-to-treat asthma. Trial Registration: Clinical Trial Registry of India CTRI/2018/11/016319; https://tinyurl.com/y78cctm3 %M 32347812 %R 10.2196/17863 %U http://www.i-jmr.org/2020/2/e17863/ %U https://doi.org/10.2196/17863 %U http://www.ncbi.nlm.nih.gov/pubmed/32347812 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e14351 %T Needs, Experiences, and Views of People With Rheumatic and Musculoskeletal Diseases on Self-Management Mobile Health Apps: Mixed Methods Study %A Najm,Aurelie %A Lempp,Heidi %A Gossec,Laure %A Berenbaum,Francis %A Nikiphorou,Elena %+ Department of Rheumatology, Nantes University Hospital, 1, Place Alexis Ricordeau, Nantes, France, 33 633444793, aurelie.najm@gmail.com %K mHealth %K mixed methods %K mobile health apps %K rheumatic and musculoskeletal disease %K smartphone %K apps %K rheumatoid arthritis, digital health, mobile health %D 2020 %7 20.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the growing interest and exponential popularity of mobile health (mHealth) apps for long-term conditions such as rheumatic and musculoskeletal diseases (RMDs) and their self-management, patients are rarely directly consulted and involved in the app development process. Objective: This study aims to explore the needs, experiences, and views of people diagnosed with RMDs on mHealth apps. Methods: The study used a mixed methods approach: (1) an initial qualitative phase via a patient focus group in the UK and (2) a survey disseminated through national organizations for patients with RMDs across European countries, the United States, Canada, and Australia. Results: The focus group included six patients with life-long musculoskeletal conditions. Half had used a self-management app at least once. The use of existing apps was reported as time-consuming due to a lack of functionality. The need for bespoke apps was voiced by all participants. Among 424 patients across European countries, the United States, Canada, and Australia, the main age group was 45 to 54 years (122/424, 28.7%), and 86.8% (368/424) were women. Half of the respondents were aware of the existence of apps to support self-management of their RMDs (188/355, 53%), with 42% (79/188) of them currently using such devices. Patients were mostly interested in an app to self-monitor their health parameters (259/346, 74.9%) and disease activity (221/346, 63.9%) or communicate directly with their health care provider (200/346, 57.8%). Conclusions: Patients considered that using an app could help them to self-manage their RMD condition if it was tailored to their needs and co-developed with health professionals. The development of such apps will require standardization and regular quality control. %M 32310151 %R 10.2196/14351 %U https://mhealth.jmir.org/2020/4/e14351 %U https://doi.org/10.2196/14351 %U http://www.ncbi.nlm.nih.gov/pubmed/32310151 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 9 %N 1 %P e13029 %T Perceived Treatment Satisfaction and Effectiveness Facilitators Among Patients With Chronic Health Conditions: A Self-Reported Survey %A Volpicelli Leonard,Kathryn %A Robertson,Courtney %A Bhowmick,Amrita %A Herbert,Leslie Beth %+ Health Union LLC, 1 International Plaza Dr, #550, Philadelphia, PA, , United States, 1 4849859715, Kate.Leonard@health-union.com %K treatment effectiveness %K patient satisfaction %K migraine %K multiple sclerosis %K rheumatoid arthritis %D 2020 %7 6.3.2020 %9 Original Paper %J Interact J Med Res %G English %X Background: Approximately 50% of patients are nonadherent to prescribed medications. Patient perception regarding medication effectiveness has been linked to improved adherence. However, how patients perceive effectiveness is poorly understood. Objective: The aim of this study was to elucidate factors associated with perceived treatment satisfaction and effectiveness among patients with chronic health conditions. Methods: We conducted a descriptive study using a cross-sectional survey design. We administered a Web-based survey to participants with migraine, multiple sclerosis (MS), or rheumatoid arthritis (RA). Patients were recruited from established online communities of Health Union. Descriptive statistics, correlations, and comparison tests were used to examine outcomes. Results: Data were collected from 1820 patients: 567 with migraine, 717 with MS, and 536 with RA. The majority of participants were female (1644/1820, 90.33%), >40 years old (1462/1820, 80.33%), and diagnosed >5 years ago (1189/1820, 65.33%). Treatment satisfaction and perceived medication effectiveness were highly correlated (r=0.90, P<.01). Overall, three temporal factors were positively correlated with satisfaction or perceived effectiveness: time on current medication (satisfaction rs=0.22, P<.01; effectiveness rs=0.25, P<.01), time since diagnosis (satisfaction rs=0.07, P<.01; effectiveness rs=0.09, P<.01), and time on treatment (effectiveness rs=0.08, P<.01). Conclusions: Findings validated the strong relationship between treatment satisfaction and perceived effectiveness. Understanding the (1) positive relationship between time and treatment satisfaction and effectiveness and (2) factors associated with determining medication effectiveness can help clinicians better understand the mindset of patients regarding treatment. Clinicians may be better prepared to elicit patient beliefs, which influence medication adherence, for people diagnosed with chronic health conditions. %M 32141836 %R 10.2196/13029 %U http://www.i-jmr.org/2020/1/e13029/ %U https://doi.org/10.2196/13029 %U http://www.ncbi.nlm.nih.gov/pubmed/32141836 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 2 %P e16767 %T Translating the Burden of Pollen Allergy Into Numbers Using Electronically Generated Symptom Data From the Patient’s Hayfever Diary in Austria and Germany: 10-Year Observational Study %A Bastl,Katharina %A Bastl,Maximilian %A Bergmann,Karl-Christian %A Berger,Markus %A Berger,Uwe %+ Aerobiology and Pollen Information Research Unit, Department of Oto-Rhino-Laryngology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria, 43 4040033380, maximilian.bastl@meduniwien.ac.at %K symptom data %K Patient’s Hayfever Diary %K pollen allergy %K symptom score calculation %D 2020 %7 21.2.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Pollen allergies affect a significant proportion of the population globally. At present, Web-based tools such as pollen diaries and mobile apps allow for easy and fast documentation of allergic symptoms via the internet. Objective: This study aimed to characterize the users of the Patient’s Hayfever Diary (PHD), a Web-based platform and mobile app, to apply different symptom score calculations for comparison, and to evaluate the contribution of organs and medications to the total score for the first time. Methods: The PHD users were filtered with regard to their location in Austria and Germany, significant positive correlation to the respective pollen type (birch/grass), and at least 15 entries in the respective season. Furthermore, 4 different symptom score calculation methods were applied to the datasets from 2009 until 2018, of which 2 were raw symptom scores and 2 were symptom load index (normalized) calculations. Pearson correlation coefficients were calculated pairwise for these 4 symptom score calculations. Results: Users were mostly male and belonged to the age groups of 21 to 40 years or >40 years. User numbers have increased in the last 5 years, especially when mobile apps were made available. The Pearson correlation coefficients showed a significant linear relationship above 0.9 among the 4 symptom score datasets and thus indicated no significant difference between the different methods of symptom score calculation. The nose contributed the most to the symptom score and determined about 40% of the score. Conclusions: The exact method of calculation of the symptom score is not critical. All computation methods show the same behavior (increase/decrease during the season). Therefore, the symptom load index is a useful computation method in all fields exploring pollen allergy, and Web-based diaries are a globally applicable tool to monitor the effect of pollen on human health via electronically generated symptom data. %M 32130130 %R 10.2196/16767 %U http://www.jmir.org/2020/2/e16767/ %U https://doi.org/10.2196/16767 %U http://www.ncbi.nlm.nih.gov/pubmed/32130130 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 2 %P e15105 %T A Smartphone App for Self-Monitoring of Rheumatoid Arthritis Disease Activity to Assist Patient-Initiated Care: Protocol for a Randomized Controlled Trial %A Seppen,Bart F %A L'ami,Merel J %A Duarte dos Santos Rico,Sharon %A ter Wee,Marieke M %A Turkstra,Franktien %A Roorda,Leo D %A Catarinella,Fabio S %A van Schaardenburg,Dirkjan %A Nurmohamed,Michael T %A Boers,Maarten %A Bos,Wouter H %+ Amsterdam Rheumatology and Immunology Center, Reade, Dr Jan van Breemenstraat 2, Amsterdam, Netherlands, 31 202421800, b.seppen@reade.nl %K smartphone app %K telemonitoring %K rheumatoid arthritis %D 2020 %7 19.2.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Telemedicine based on self-measurement of disease activity could be one of the key components to create the health care system of the future. Previous publications in various medical fields have shown that it is possible to safely telemonitor patients while reducing the number of outpatient clinic visits. For this purpose, we developed a mobile phone app for patients with rheumatoid arthritis (RA), which allows them to self-monitor their disease. Objective: The objective of this study is to assess the safety and efficacy of self-initiated care assisted by a smartphone app in patients with RA. Methods: This is a randomized controlled trial that will be performed for 1 year. A total of 176 patients with RA will be randomized to either self-initiated care with only one scheduled follow-up consultation assisted by our app or usual care. The coprimary outcome measures are the number of outpatient clinic consultations with a rheumatologist taking place during the trial period and the mean disease activity score as measured by the disease activity score 28 (DAS28) at 12 months. The secondary outcomes are patient satisfaction, adherence, patient empowerment, and cost evaluation of health care assisted by the app. Results: Recruitment started in May 2019, and up to 18 months will be required for completion of recruitment. Thus far, 78 patients have been randomized, and thus far, experiences with the app have been positive. The study results are expected to be published by the end of 2021. Conclusions: The completion of this study will provide important data regarding the following: (1) safety of self-initiated care supported by a smartphone app in terms of DAS28 and (2) efficacy of lowering health care usage with this new strategy of providing health care. Trial Registration: Netherlands Trial Register NL7715; https://www.trialregister.nl/trial/7715 International Registered Report Identifier (IRRID): DERR1-10.2196/15105 %M 32130182 %R 10.2196/15105 %U http://www.researchprotocols.org/2020/2/e15105/ %U https://doi.org/10.2196/15105 %U http://www.ncbi.nlm.nih.gov/pubmed/32130182 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 12 %P e15987 %T Exploring the Characteristics and Preferences for Online Support Groups: Mixed Method Study %A Plinsinga,Melanie Louise %A Besomi,Manuela %A Maclachlan,Liam %A Melo,Luciano %A Robbins,Sarah %A Lawford,Belinda J %A Teo,Pek Ling %A Mills,Kathryn %A Setchell,Jenny %A Egerton,Thorlene %A Eyles,Jillian %A Hall,Leanne %A Mellor,Rebecca %A Hunter,David J %A Hodges,Paul %A Vicenzino,Bill %A Bennell,Kim %+ Centre for Health, Exercise, and Sports Medicine, Department of Physiotherapy, University of Melbourne, Alan Gilbert Building, 161 Barry Street, Carlton, 3053, Australia, 61 3 8344 4135, k.bennell@unimelb.edu.au %K osteoarthritis %K self-help groups %K self-management %K surveys and questionnaires %D 2019 %7 3.12.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Osteoarthritis (OA) is a chronic, disabling, and prevalent disorder. As there is no cure for OA, long-term self-management is paramount. Support groups (SGs) can facilitate self-management among people living with OA. Understanding preferences in design and features of SGs, including online SGs (OSGs), among people with OA can inform future development of SG interventions for this condition. Objective: The objective of this study was to investigate health care– and health information–seeking behavior, digital literacy, and preferences for the design of SGs in people with OA. The study also explored the perceived barriers and enablers to being involved in OSGs. Methods: An online survey study was conducted with a mixed method design (quantitative and qualitative). Individuals aged ≥45 years with knee, hip, or back pain for ≥3 months were recruited from an extant patient database of the Institute of Bone and Joint Research via email invitations. Quantitative elements of the survey included questions about sociodemographic background; health care– and health information–seeking behavior; digital literacy; and previous participation in, and preferences for, SGs and OSGs. Respondents were classified into 2 groups (Yes-SG and No-SG) based on previous participation or interest in an SG. Group differences were assessed with Chi-square tests (significance level set at 5%). Responses to free-text questions relating to preferences regarding OSG engagement were analyzed qualitatively using an inductive thematic analysis. Results: A total of 415 people with OA completed the survey (300/415, 72.3% females; 252/415, 61.0% lived in a major city). The Yes-SG group included 307 (307/415, 73.9%) participants. Between the Yes-SG and No-SG groups, there were no differences in sociodemographic characteristics, health care– and health information–seeking behavior, and digital literacy. An online format was preferred by 126/259 (48.7%) of the Yes-SG group. Trained peer facilitators were preferred, and trustworthiness of advice and information were highly prioritized by the respondents. Qualitative analysis for OSG participation revealed 5 main themes. Lack of time and motivation were the main barriers identified. The main enablers were related to accessibility, enjoyment of the experience, and the content of the discussed information. Conclusions: These findings highlight the preferences in design features and content of SGs and OSGs and may assist in the further development of such groups. %M 31793893 %R 10.2196/15987 %U https://www.jmir.org/2019/12/e15987 %U https://doi.org/10.2196/15987 %U http://www.ncbi.nlm.nih.gov/pubmed/31793893 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e14730 %T Mobile Health Apps for Self-Management of Rheumatic and Musculoskeletal Diseases: Systematic Literature Review %A Najm,Aurélie %A Gossec,Laure %A Weill,Catherine %A Benoist,David %A Berenbaum,Francis %A Nikiphorou,Elena %+ Department of Rheumatology, Nantes University Hospital, 1, place Alexis Ricordeau, Nantes, 44000, France, 33 633444793, aurelie.najm@gmail.com %K mobile health %K self-management %K arthritis %K telemedicine %K musculoskeletal diseases %D 2019 %7 26.11.2019 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Although the increasing availability of mobile health (mHealth) apps may enable people with rheumatic and musculoskeletal diseases (RMDs) to better self-manage their health, there is a general lack of evidence on ways to ensure appropriate development and evaluation of apps. Objective: This study aimed to obtain an overview on existing mHealth apps for self-management in patients with RMDs, focusing on content and development methods. Methods: A search was performed up to December 2017 across 5 databases. For each publication relevant to an app for RMDs, information on the disease, purpose, content, and development strategies was extracted and qualitatively assessed. Results: Of 562 abstracts, 32 were included in the analysis. Of these 32 abstracts, 11 (34%) referred to an app linked to a connected device. Most of the apps targeted rheumatoid arthritis (11/32, 34%). The top three aspects addressed by the apps were pain (23/32, 71%), fatigue (15/32, 47%), and physical activity (15/32, 47%). The development process of the apps was described in 84% (27/32) of the articles and was of low to moderate quality in most of the cases. Despite most of the articles having been published within the past two years, only 5 apps were still commercially available at the time of our search. Moreover, only very few studies showed improvement of RMD outcome measures. Conclusions: The development process of most apps was of low or moderate quality in many studies. Owing to the increasing RMD patients’ willingness to use mHealth apps for self-management, optimal standards and quality assurance of new apps are mandatory. %M 31769758 %R 10.2196/14730 %U https://mhealth.jmir.org/2019/11/e14730 %U https://doi.org/10.2196/14730 %U http://www.ncbi.nlm.nih.gov/pubmed/31769758 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 4 %P e12225 %T How Do Publicly Available Allergy-Specific Web-Based Training Programs Conform to the Established Criteria for the Reporting, Methods, and Content of Evidence-Based (Digital) Health Information and Education: Thematic Content Evaluation %A Lander,Jonas %A Drixler,Karin %A Dierks,Marie-Luise %A Bitzer,Eva Maria %+ Freiburg University of Education, Department of Public Health and Health Education, Kartäuserstraße 47, Freiburg, 79117, Germany, 49 761 682 142, evamaria.bitzer@ph-freiburg.de %K allergy %K asthma %K health communication %K health education %K health information systems %K evidence-based practice %D 2019 %7 24.10.2019 %9 Original Paper %J Interact J Med Res %G English %X Background: Allergic diseases, such as allergic asthma, rhinitis, and atopic eczema, are widespread, and they are a considerable burden on the health care system. For patients and health care professionals, Web-based training programs may be helpful to foster self-management and provide allergy-specific information, given, for instance, their good accessibility. Objective: This study aimed to assess an exploratory sample of publicly available allergy-specific Web-based training programs—that is, interactive, feedback-oriented Web-based training platforms promoting health behavior change and improvement of personal skills—with regard to (1) general characteristics, aims, and target groups and (2) the extent to which these tools meet established criteria for the reporting, methods, and content of evidence-based (digital) health information and education. Methods: Web-based training programs were identified via an initial Google search and a search of English and German language websites of medical and public health services, such as the European Centre for Allergy Research Foundation (German), Asthma UK, and Anaphylaxis Canada. We developed a checklist from (1) established guidelines for Web-based health information (eg, the Journal of the American Medical Association benchmarks, DISCERN criteria, and Health On the Net code) and (2) a database search of related studies. The checklist contained 44 items covering 11 domains in 3 areas: (1) content (completeness, transparency, and evidence), (2) structure (data safety and qualification of trainers and authors), and (3) impact (effectiveness, user perspective, and integration into health care). We rated the Web-based training programs as completely, partly, or not satisfying each checklist item and calculated overall and domain-specific scores for each Web-based training program using SPSS 23.0 (SPSS Inc). Results: The 15 identified Web-based training programs covered an average of 37% of the items (score 33 out of 88). A total of 7 Web-based training programs covered more than 40% (35/88; maximum: 49%; 43/88). A total of 5 covered 30% (26/88) to 40% (35/88) of all rated items and the rest covered fewer (n=3; lowest score 24%; 21/88). Items relating to intervention (58%; 10/18), content (49%; 9/18), and data safety (60%; 1/2) were more often considered, as opposed to user safety (10%; 0.4/4), qualification of staff (10%; 0.8/8), effectiveness (16%; 0.4/2), and user perspective (45%; 5/12). In addition, in 13 of 15 Web-based training programs, a minimum of 3 domains were not covered at all. Regarding evidence-based content, 46% of all Web-based training programs (7/15) scored on use of scientific research, 53% on regular information update (8/15), and 33% on provision of references (5/15). None of 15 provided details on the quality of references or the strength of evidence. Conclusions: English and German language allergy-specific Web-based training programs, addressing lay audiences and health care professionals, conform only partly to established criteria for the reporting, methods, and content of evidence-based (digital) health information and education. Particularly, well-conducted studies on their effectiveness are missing. %M 31651401 %R 10.2196/12225 %U http://www.i-jmr.org/2019/4/e12225/ %U https://doi.org/10.2196/12225 %U http://www.ncbi.nlm.nih.gov/pubmed/31651401 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 8 %P e13414 %T Proximity-Based Emergency Response Communities for Patients With Allergies Who Are at Risk of Anaphylaxis: Clustering Analysis and Scenario-Based Survey Study %A Gaziel Yablowitz,Michal %A Dölle,Sabine %A Schwartz,David G %A Worm,Margitta %+ Allergy-Centre-Charite, Department of Dermatology and Allergy, Charite-Universitatsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Berlin,, Germany, 49 30 450 518092, margitta.worm@charite.de %K consumer health informatics %K anaphylaxis %K emergency responders %K social networking %K telemedicine %D 2019 %7 22.08.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Anaphylaxis is a potentially fatal allergic reaction. However, many patients at risk of anaphylaxis who should permanently carry a life-saving epinephrine auto injector (EAI) do not carry one at the moment of allergen exposure. The proximity-based emergency response communities (ERC) strategy suggests speeding EAI delivery by alerting patient-peers carrying EAI to respond and give their EAI to a nearby patient in need. Objectives: This study had two objectives: (1) to analyze 10,000 anaphylactic events from the European Anaphylaxis Registry (EAR) by elicitor and location in order to determine typical anaphylactic scenarios and (2) to identify patients’ behavioral and spatial factors influencing their response to ERC emergency requests through a scenario-based survey. Methods: Data were collected and analyzed in two phases: (1) clustering 10,000 EAR records by elicitor and incident location and (2) conducting a two-center scenario-based survey of adults and parents of minors with severe allergy who were prescribed EAI, in Israel and Germany. Each group received a four-part survey that examined the effect of two behavioral constructs—shared identity and diffusion of responsibility—and two spatial factors—emergency time and emergency location—in addition to sociodemographic data. We performed descriptive, linear correlation, analysis of variance, and t tests to identify patients’ decision factors in responding to ERC alerts. Results: A total of 53.1% of EAR cases were triggered by food at patients’ home, and 46.9% of them were triggered by venom at parks. Further, 126 Israeli and 121 German participants completed the survey and met the inclusion criteria. Of the Israeli participants, 80% were parents of minor patients with a risk of anaphylaxis due to food allergy; their mean age was 32 years, and 67% were women. In addition, 20% were adult patients with a mean age of 21 years, and 48% were female. Among the German patients, 121 were adults, with an average age of 47 years, and 63% were women. In addition, 21% were allergic to food, 75% were allergic to venom, and 2% had drug allergies. The overall willingness to respond to ERC events was high. Shared identity and the willingness to respond were positively correlated (r=0.51, P<.001) in the parent group. Parents had a stronger sense of shared identity than adult patients (t243= –9.077, P<.001). The bystander effect decreased the willingness of all patients, except the parent group, to respond (F1,269=28.27, P<.001). An interaction between location and time of emergency (F1,473=77.304, P<.001) revealed lower levels of willingness to respond in strange locations during nighttime. Conclusions: An ERC allergy app has the potential to improve outcomes in case of anaphylactic events, but this is dependent on patient-peers’ willingness to respond. Through a two-stage process, our study identified the behavioral and spatial factors that could influence the willingness to respond, providing a basis for future research of proximity-based mental health communities. %M 31441432 %R 10.2196/13414 %U http://mhealth.jmir.org/2019/8/e13414/ %U https://doi.org/10.2196/13414 %U http://www.ncbi.nlm.nih.gov/pubmed/31441432 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 2 %P e10812 %T Perceptions of Food Hypersensitivity Expertise on Social Media: Qualitative Study %A Hamshaw,Richard James Thomas %A Barnett,Julie %A Gavin,Jeff %A Lucas,Jane S %+ Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom, 44 1225 38 ext 5293, R.J.T.Hamshaw@bath.ac.uk %K social media %K food allergy %K food hypersensitivity %K celiac disease %K food intolerance %K interviews as topic %K qualitative methods %D 2019 %7 28.06.2019 %9 Original Paper %J Interact J Med Res %G English %X Background: Seeking and sharing information are the primary uses of the internet and social media. It is therefore vital to understand the processes individuals go through when engaging with information on these diverse platforms, especially in areas such as health- and risk-related information. One important element of such engagement is evaluating and attributing expertise to others. Objective: This study aimed to explore how meanings around expertise in relation to food allergy and intolerance (food hypersensitivity) were constructed by 2 groups of social media users: (1) those who use platforms for reasons relating to food hypersensitivity and (2) those seen as experts by this community. Methods: Survey participants were asked open-ended questions to identify potential experts in food hypersensitivity issues on social media and to discuss their reasoning for their choices (n=143). Subsequently, 8 adult social media users with experience of managing food hypersensitivity and 5 participants designated as experts by those users took part in email interviews. Survey and interview data were analyzed thematically using Braun and Clarke’s approach. Results: Judging expertise on social media is a complex and multifaceted process. Users might be judged as experts through their professional background or their experience living with food hypersensitivities. How users behave on social media and the traces of their Web-based activity can influence how others will see them. Such considerations are both measured and moderated through the social media community itself. Findings highlighted how social media often act as a supportive information tool following a diagnosis, but this also raised concerns regarding the scenario of patients not being able to access suitable vetted information. Conclusions: This work has implications for understanding how users perceive expertise on social media in relation to a health concern and how information assessments are made during the management of risks. Findings provide practical insights to both medical and organizational stakeholders involved in the support of those living with life-changing conditions, such as food hypersensitivities. %M 31254334 %R 10.2196/10812 %U http://www.i-jmr.org/2019/2/e10812/ %U https://doi.org/10.2196/10812 %U http://www.ncbi.nlm.nih.gov/pubmed/31254334 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 2 %P e13698 %T Using Virtual Reality to Improve Antiretroviral Therapy Adherence in the Treatment of HIV: Open-Label Repeated Measure Study %A Liran,Omer %A Dasher,Robert %A Kaeochinda,Kevin %+ Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California - Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 91604, United States, 1 (310) 825 6373, oliran@ucla.edu %K HAART %K technology %K virtual reality %K medication adherence %K viral load %K education %D 2019 %7 20.06.2019 %9 Original Paper %J Interact J Med Res %G English %X Background: Nonadherence to HIV medications is a serious unsolved problem and is a major cause of morbidity and mortality in the HIV-positive population. Although treatment efficacy is high if compliance is greater than 90%, about 40% of people with HIV do not meet this threshold. Objective: This study aimed to test a novel approach to improve medication adherence by using a low-cost virtual reality (VR) experience to educate people with HIV about their illness. We hypothesized that people with HIV would be more likely to be compliant with the treatment following the 7-minute experience and, therefore, should have decreasing viral load (VL), increasing cluster of differentiation 4+ (CD4+) cell counts, and improved self-reported adherence. Methods: We showed the VR experience to 107 participants with HIV at a county hospital in Los Angeles, California. Participants were asked to self-report how often they take their medications on a Likert-scale. The self-reported question (SRQ) was given before and at least 2 weeks after the VR experience. We also compared VL and CD4+ cell counts before and on average 101 days after the experience. VL and CD4+ were obtained per the clinic’s standard care protocol. Two-tailed paired t tests were performed on the initial and follow-up SRQ scores, VL, and CD4+. We restricted the CD4+ analysis to participants who had a pre-CD4+ below normal (defined as 500 cells/mm3). To reduce the possibility that VL were trending down and CD4+ were trending up regardless of the VR experience, 2 serial VL and CD4+ obtained before the experience were also compared and analyzed. Immediately following the VR experience, participants were given a 4-question Likert-type postexperience questionnaire (PEQ) that assessed their opinions about the experience. Results: SRQ scores improved from pre to post experience with high significance (P<.001). VL decreased from pre to post experience by 0.38 log10 copies/mL (95% CI 0.06-0.70; P=.02). In contrast, the 2 serial VL obtained before the experience showed no statistically significant changes. There was also a statistically significant increase in CD4+ (95% CI –3.4 to –54.3 cells/mm3; P=.03). Analysis of the PEQ revealed that VR was comfortable for almost all of the participants and that most participants believed the experience to be educational and that it would improve their medication adherence. Conclusions: The findings suggest that the low-cost VR experience caused an increased rate of antiretroviral therapy adherence that resulted in a decrease of VL and an increase of CD4+. Further studies are required to explore the duration of this effect and whether these results are generalizable to other treatment settings and populations. %M 31223117 %R 10.2196/13698 %U http://www.i-jmr.org/2019/2/e13698/ %U https://doi.org/10.2196/13698 %U http://www.ncbi.nlm.nih.gov/pubmed/31223117 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 5 %N 1 %P e12605 %T YouTube Videos as a Source of Information About Immunology for Medical Students: Cross-Sectional Study %A Van den Eynde,Jef %A Crauwels,Alexander %A Demaerel,Philip Georg %A Van Eycken,Lisa %A Bullens,Dominique %A Schrijvers,Rik %A Toelen,Jaan %+ Department of Development and Regeneration, KU Leuven, Herestraat 49, Leuven, 3000, Belgium, 32 16 34 39 91, jaan.toelen@uzleuven.be %K antigen presentation %K education %K immunoglobulins %K immunology %K learning %K students %D 2019 %7 28.05.2019 %9 Original Paper %J JMIR Med Educ %G English %X Background: The use of the internet as a source of information has grown exponentially in the last decade. YouTube is currently the second most visited website and a major Web-based educational resource for medical students. Objective: The aim of this study was to evaluate the quality, accuracy, and attractiveness of the information acquired from YouTube videos about 2 central concepts in immunology. Methods: YouTube videos posted before August 27, 2018 were searched using selected keywords related to either antigen presentation or immunoglobulin gene rearrangement. Video characteristics were recorded, and the Video Power Index (VPI) was calculated. Videos were assessed using 5 validated scoring systems: understandability and attractiveness, reliability, content and comprehensiveness, global quality score (GQS), and a subjective score. Videos were categorized by educational usefulness and by source. Results: A total of 82 videos about antigen presentation and 70 about immunoglobulin gene rearrangement were analyzed. Videos had a mean understandability and attractiveness score of 6.57/8 and 5.84/8, content and comprehensiveness score of 9.84/20 and 5.84/20, reliability score of 1.65/4 and 1.53/4, GQS of 3.38/5 and 2.76/5, and subjective score of 2.00/3 and 2.00/3, respectively. The organized channels group tended to have the highest VPI and GQS. Conclusions: YouTube can provide medical students with some useful information about immunology, although content wise it cannot substitute textbooks and academic courses. Students and teachers should be aware of the educational quality of available videos if they intend to use them in the context of blended learning. %M 31140440 %R 10.2196/12605 %U http://mededu.jmir.org/2019/1/e12605/ %U https://doi.org/10.2196/12605 %U http://www.ncbi.nlm.nih.gov/pubmed/31140440 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e10450 %T Causal Relationships Among Pollen Counts, Tweet Numbers, and Patient Numbers for Seasonal Allergic Rhinitis Surveillance: Retrospective Analysis %A Wakamiya,Shoko %A Matsune,Shoji %A Okubo,Kimihiro %A Aramaki,Eiji %+ Institute for Research Initiatives, Nara Institute of Science and Technology, 8916-5 Takayama-cho, Ikoma, 630-0192, Japan, 81 743726053, wakamiya@is.naist.jp %K seasonal allergic rhinitis %K social media %K Twitter %K causal relationship %K infoveillance %K disease surveillance %D 2019 %7 20.02.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Health-related social media data are increasingly used in disease-surveillance studies, which have demonstrated moderately high correlations between the number of social media posts and the number of patients. However, there is a need to understand the causal relationship between the behavior of social media users and the actual number of patients in order to increase the credibility of disease surveillance based on social media data. Objective: This study aimed to clarify the causal relationships among pollen count, the posting behavior of social media users, and the number of patients with seasonal allergic rhinitis in the real world. Methods: This analysis was conducted using datasets of pollen counts, tweet numbers, and numbers of patients with seasonal allergic rhinitis from Kanagawa Prefecture, Japan. We examined daily pollen counts for Japanese cedar (the major cause of seasonal allergic rhinitis in Japan) and hinoki cypress (which commonly complicates seasonal allergic rhinitis) from February 1 to May 31, 2017. The daily numbers of tweets that included the keyword “kafunshō” (or seasonal allergic rhinitis) were calculated between January 1 and May 31, 2017. Daily numbers of patients with seasonal allergic rhinitis from January 1 to May 31, 2017, were obtained from three healthcare institutes that participated in the study. The Granger causality test was used to examine the causal relationships among pollen count, tweet numbers, and the number of patients with seasonal allergic rhinitis from February to May 2017. To determine if time-variant factors affect these causal relationships, we analyzed the main seasonal allergic rhinitis phase (February to April) when Japanese cedar trees actively produce and release pollen. Results: Increases in pollen count were found to increase the number of tweets during the overall study period (P=.04), but not the main seasonal allergic rhinitis phase (P=.05). In contrast, increases in pollen count were found to increase patient numbers in both the study period (P=.04) and the main seasonal allergic rhinitis phase (P=.01). Increases in the number of tweets increased the patient numbers during the main seasonal allergic rhinitis phase (P=.02), but not the overall study period (P=.89). Patient numbers did not affect the number of tweets in both the overall study period (P=.24) and the main seasonal allergic rhinitis phase (P=.47). Conclusions: Understanding the causal relationships among pollen counts, tweet numbers, and numbers of patients with seasonal allergic rhinitis is an important step to increasing the credibility of surveillance systems that use social media data. Further in-depth studies are needed to identify the determinants of social media posts described in this exploratory analysis. %M 30785411 %R 10.2196/10450 %U http://www.jmir.org/2019/2/e10450/ %U https://doi.org/10.2196/10450 %U http://www.ncbi.nlm.nih.gov/pubmed/30785411 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 7 %N 2 %P e18 %T Extrahepatic Autoimmune Diseases are Prevalent in Autoimmune Hepatitis Patients and Their First-Degree Relatives: Survey Study %A Fogel,Rachel %A Comerford,Megan %A Chilukuri,Prianka %A Orman,Eric %A Chalasani,Naga %A Lammert,Craig %+ Division of Gastroenterology and Hepatology, Indiana University, 702 Rotary Circle, Indianapolis, IN,, United States, 1 3172746492, clammert@iu.edu %K autoimmune hepatitis %K first-degree relatives %K social media %D 2018 %7 19.12.2018 %9 Original Paper %J Interact J Med Res %G English %X Background: Concurrent autoimmune illnesses contribute to increased medical burden and reduced quality of life in patients with autoimmune hepatitis (AIH). The frequency of coexisting autoimmune conditions among North American patients with AIH and their families remains incomplete. Challenges associated with disease capture in the electronic medical record, high study costs, and geographic spread of patients are formidable barriers to understanding the extent of concurrent autoimmune conditions in these groups. Objective: This objective of this study was to examine the frequency of extrahepatic autoimmune diseases (EHAD) among AIH cases and healthy controls as well as their first-degree relatives using social networking sites (SNS). Methods: We developed a 53-question survey detailing the history of autoimmune diseases. A survey link was posted at routine intervals within specific Web-based cohorts on SNS. Healthy controls, without self-reported autoimmune liver disease, were recruited from Amazon’s Mechanical Turk. Continuous variables were summarized using medians and P values obtained with the Wilcoxon rank-sum test. Categorical variables were compared using the chi-square test. Results: Compared with controls (n=1162), cases (n=306) were more likely to be older (median age: 49 vs 33 years), female (284/306, 92.81% vs 955/1162, 82.18%), and have an EHAD (128/306, 41.83% vs 218/1162, 18.76%; P=.001). The most frequent EHADs among cases were thyroid disease (49/306, 16.01% ), Sjögren syndrome (27/306, 8.82%), Raynaud phenomenon (23/306, 7.52%), and psoriasis (22/306, 7.19%). Overall, 55.88% (171/306) of cases and 35.71% (1601/4484) of controls reported at least 1 first-degree relative (FDR) with a history of EHAD (P=.001). Cases had a significantly higher risk of EHAD than controls after the adjustment for age, sex, race, and body mass index: odds ratio 2.46 (95% CI 1.8-3.3); P=.001. Conclusions: Patients with AIH report higher prevalence of coexistent EHAD than healthy controls, and their FDRs are also more likely to have autoimmune disorders. %M 30567687 %R 10.2196/ijmr.9625 %U http://www.i-jmr.org/2018/2/e18/ %U https://doi.org/10.2196/ijmr.9625 %U http://www.ncbi.nlm.nih.gov/pubmed/30567687 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 4 %P e11354 %T Conurbation, Urban, and Rural Living as Determinants of Allergies and Infectious Diseases: Royal College of General Practitioners Research and Surveillance Centre Annual Report 2016-2017 %A de Lusignan,Simon %A McGee,Christopher %A Webb,Rebecca %A Joy,Mark %A Byford,Rachel %A Yonova,Ivelina %A Hriskova,Mariya %A Matos Ferreira,Filipa %A Elliot,Alex J %A Smith,Gillian %A Rafi,Imran %+ Department of Clinical and Experimental Medicine, University of Surrey, Leggett Building, Daphne Jackson Road, Guildford,, United Kingdom, 44 01483 6848002, s.lusignan@surrey.ac.uk %K population surveillance %K respiratory tract infections %K conjunctivitis, allergic %K asthma %K urinary tract infections %K gastroenteritis %K healthcare disparities %K socioeconomic factors %K social determinants of health %K medical records systems, computerized %K data collection %K records as topic %K primary health care %K general practice %K infectious diseases %D 2018 %7 26.11.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Living in a conurbation, urban, or rural environment is an important determinant of health. For example, conurbation and rural living is associated with increased respiratory and allergic conditions, whereas a farm or rural upbringing has been shown to be a protective factor against this. Objective: The objective of the study was to assess differences in general practice presentations of allergic and infectious disease in those exposed to conurbation or urban living compared with rural environments. Methods: The population was a nationally representative sample of 175 English general practices covering a population of over 1.6 million patients registered with sentinel network general practices. General practice presentation rates per 100,000 population were reported for allergic rhinitis, asthma, and infectious conditions grouped into upper and lower respiratory tract infections, urinary tract infection, and acute gastroenteritis by the UK Office for National Statistics urban-rural category. We used multivariate logistic regression adjusting for age, sex, ethnicity, deprivation, comorbidities, and smoking status, reporting odds ratios (ORs) with 95% CIs. Results: For allergic rhinitis, the OR was 1.13 (95% CI 1.04-1.23; P=.003) for urban and 1.29 (95% CI 1.19-1.41; P<.001) for conurbation compared with rural dwellers. Conurbation living was associated with a lower OR for both asthma (OR 0.70, 95% CI 0.67-0.73; P<.001) and lower respiratory tract infections (OR 0.94, 95% CI 0.90-0.98; P=.005). Compared with rural dwellers, the OR for upper respiratory tract infection was greater in urban (OR 1.06, 95% CI 1.03-1.08; P<.001) but no different in conurbation dwellers (OR 1.00, 95% CI 0.97-1.03; P=.93). Acute gastroenteritis followed the same pattern: the OR was 1.13 (95% CI 1.01-1.25; P=.03) for urban dwellers and 1.04 (95% CI 0.93-1.17; P=.46) for conurbation dwellers. The OR for urinary tract infection was lower for urban dwellers (OR 0.94, 95% CI 0.89-0.99; P=.02) but higher in conurbation dwellers (OR 1.06, 95% CI 1.00-1.13; P=.04). Conclusions: Those living in conurbations or urban areas were more likely to consult a general practice for allergic rhinitis and upper respiratory tract infection. Both conurbation and rural living were associated with an increased risk of urinary tract infection. Living in rural areas was associated with an increased risk of asthma and lower respiratory tract infections. The data suggest that living environment may affect rates of consultations for certain conditions. Longitudinal analyses of these data would be useful in providing insights into important determinants. %M 30478022 %R 10.2196/11354 %U http://publichealth.jmir.org/2018/4/e11354/ %U https://doi.org/10.2196/11354 %U http://www.ncbi.nlm.nih.gov/pubmed/30478022 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 6 %N 2 %P e8 %T Toward a New Kind of Vaccine: A Logical Extension of the Symmetrical Immune Network Theory %A Gorczynski,Reginald %A Hoffmann,Geoffrey %+ University of Toronto, 2-805 TMDT, 101 College Street, Toronto, ON, M5G1L7, Canada, 1 647 267 9739, reg.gorczynski@utoronto.ca %K immunity %K anti-idiotype antibodies immune system concepts %K information networks %D 2017 %7 05.07.2017 %9 Original Paper %J Interact J Med Res %G English %X Background: The symmetrical immune network theory, developed in 1975, is based on the existence of specific T cell factors and hypothesizes that normal IgG immune responses comprise the production of 2 kinds of antibodies, namely antigen-specific antibodies and anti-idiotypic antibodies. Objective: The aim of this study was to confirm the existence of specific T cells factors and to show that immunization of C3H mice with BL/6 skin or using nominal antigen for immunization (Tetanus Toxoid) induced production of antigen-specific (anti-BL/6 or antitetanus) antibodies plus anti-idiotypic antibodies (C3H anti-anti-C3H). Subsequently, we investigated the role of combinations of antigen-specific and anti-idiotype antibodies in a variety of animal models of clinical diseases. Methods: Antigen-specific antibodies were produced by conventional immunization of mice (eg, with tetanus toxoid or by skin allografting). Subsequent anti-idiotypic antibodies were derived by exhaustive absorption of antigen-specific antibody, with confirmation of anti-idiotypic specificity by binding to relevant target antigen-specific antibodies in an enzyme-linked immunosorbent assay (ELISA). Antigen-specific plus anti-idiotypic antibodies were then used to modulate skin allograft survival, dextran sulfate sodium (DSS)-induced colitis, ovalbumin (OVA)-induced IgE production, and breast cancer growth in mice. Results: Infusions of anti-BL/6 antibodies together with BL/6 anti-anti-BL/6 antibodies specifically suppressed (>85%) an immune response to BL/6 lymphocytes in C3H mice. The two kinds of antibodies with complementary specificity are hypothesized to stimulate 2 populations of T lymphocytes. Coselection of these 2 populations leads to a new stable steady state of the system with diminished reactivity to BL/6 tissue. A combination of anti-C3H and C3H anti‑anti-C3H IgG antibodies down-regulated inflammation in a mouse model of inflammatory bowel disease (>75%) and attenuated anti-IgE production and sensitization to produce IL4 cytokines (>70%) in an OVA-allergy model. Combination of C3H anti‑BL/6 and BL/6 anti-anti-BL/6 antibodies decreased tumor growth and metastases (>705) in an EMT6 transplantable breast cancer model. Conclusions: Use of a combination of antigen-specific and anti-idiotypic antibodies has potential as a new class of vaccines. %M 28679488 %R 10.2196/ijmr.7612 %U http://www.i-jmr.org/2017/2/e8/ %U https://doi.org/10.2196/ijmr.7612 %U http://www.ncbi.nlm.nih.gov/pubmed/28679488