TY - JOUR AU - Rotondo, Jenny AU - VanSteelandt, Amanda AU - Kouyoumdjian, Fiona AU - Bowes, J. Matthew AU - Kakkar, Tanya AU - Jones, Graham AU - Abele, Brandi AU - Murray, Regan AU - Schleihauf, Emily AU - Halverson, Jessica AU - Leason, Jennifer AU - Huyer, Dirk AU - Jackson, Beth AU - Bozat-Emre, Songul AU - Shah, Devanshi AU - Rees, E. Erin PY - 2025/4/10 TI - Substance-Related Acute Toxicity Deaths in Canada From 2016 to 2017: Protocol for a Retrospective Chart Review Study of Coroner and Medical Examiner Files JO - JMIR Public Health Surveill SP - e49981 VL - 11 KW - acute toxicity KW - Canada KW - chart review study KW - coroner KW - death investigations KW - drug overdose KW - medical examiner KW - mortality KW - poisoning KW - protocol N2 - Background: Canada continues to experience a national overdose crisis. While studies are available at the regional, provincial, and territorial levels, detailed national data regarding the burden and context of substance-related acute toxicity deaths are limited, particularly in subpopulations. In response to the overdose crisis, the Public Health Agency of Canada, in collaboration with provincial and territorial ministries of health and chief coroner and chief medical examiner offices, has undertaken a national chart review study. Objective: This study was conducted to describe and compare the characteristics of substance-related acute toxicity deaths that occurred in Canada between 2016 and 2017, including descriptions of those who died, the substances involved, and the circumstances surrounding their deaths. This paper describes the study methodology in detail. Methods: This retrospective, population-based, and cross-sectional study involved the review of coroner and medical examiner files for deaths that met the study case definition. Data were collected on demographic and socioeconomic characteristics, medical and substance use history, proximal circumstances surrounding the death, and toxicology findings using a standardized data collection tool that underwent 2 pilot studies. Data abstractors underwent training and regular intrarater reliability exercises with a fictitious death investigation file. Data quality was assessed based on the consistency of abstractor intrarater reliability scores and the completeness of core variables and variables for key concepts. Data were linked to national datasets to allow for the examination of area-level geographic and socioeconomic characteristics. Descriptive analyses will examine differences across subpopulations and the general Canadian population. Latent class, spatiotemporal, qualitative, and premature death analyses are also planned. Where possible, analyses will be stratified by the manner of death and sex. Results: The study began in the summer of 2018, and abstraction was delayed due to the COVID-19 pandemic. All activities are expected to be completed by early 2025. A total of 9414 coroner and medical examiner files met the study case definition. Most abstractors (25/26, 96%) met the established threshold for consistency throughout abstraction without the need for remedial training. In general, core study variables, including geographic variables and substances contributing to death, had very good availability. Study variables related to the person?s health, history of substance use, and events surrounding the acute toxicity event were available for most records. Socioeconomic variables and variables describing socially constructed identities and potentially traumatic life events were mostly unavailable. Conclusions: This study provides the most detailed national information on substance-related acute toxicity deaths in Canada to date and can serve as a pre?COVID-19 pandemic baseline for assessing the evolution of the overdose crisis. Results can inform policies and programs to address the overdose crisis, the development of common approaches to medicolegal death investigations, and future research activities. UR - https://publichealth.jmir.org/2025/1/e49981 UR - http://dx.doi.org/10.2196/49981 UR - http://www.ncbi.nlm.nih.gov/pubmed/40208661 ID - info:doi/10.2196/49981 ER - TY - JOUR AU - Yadav, Vijay AU - Neto, Chaibub Elias AU - Doerr, Megan AU - Pratap, Abhishek AU - Omberg, Larsson PY - 2025/3/19 TI - Long-Term Engagement of Diverse Study Cohorts in Decentralized Research: Longitudinal Analysis of ?All of Us? Research Program Data JO - Interact J Med Res SP - e56803 VL - 14 KW - digital health KW - engagement behavior KW - All of Us Research Program KW - retention KW - decentralized research cohorts N2 - Background: The generalizability of clinical research hinges on robust study designs, which include the recruitment and maintenance of a representative study population. This study examines the evolution of the demographic characteristics of 329,038 participants who enrolled and participated in The All of Us Research Program (AoURP), a decentralized study aimed at representing the diversity of the United States. Objective: The primary objectives of this study were to assess alterations in the demographic composition of the cohort at different protocol stages within AoURP, while analyzing completion rates and timeframes for survey and substudy completion. Additionally, we examined how participant interactions with the program impacted engagement and survey responses. Methods: We conducted a longitudinal analysis of the AoURP data, tracking changes in demographic composition, completion rates, and completion times for surveys and substudies. Comparative analyses were performed to assess differences in engagement and survey completion based on sociodemographic characteristics of participants involved in postenrollment study components. Results: The sociodemographic composition of the cohort that participated in the postenrollment study (eg, optional components) differed significantly from that of the recruited population. The proportion of self-identified White participants increased by 21.2%, whereas the proportion of Black or African American participants decreased by 12.18% (P=.02). Participants who identified as White (n=93,614, 52.7%) and NonHispanic (n=109,279, 42.21%) were more engaged compared to those identifying as Black or African American (n=10,887, 15.76%), Asian (n=4274, 38.72%), or Hispanic (n=12,530, 20.7%; P=.006). Participants? response times to study surveys and completeness varied across all demographic groups (P<.001). Furthermore, those identifying as White skipped fewer survey questions (1.19) compared to those identifying as Black or African American (1.40) or other racial and ethnic identities (P<.001). Conclusions: The AoURP dataset serves as an exceptional resource for investigating diverse public health concerns. However, the longitudinal analysis of participant-level data underscores a significant skew in population diversity, suggesting the need for targeted strategies to enhance engagement and retention across all groups. Ensuring diversity in the cohort is essential for maintaining the study?s representativeness and the broad applicability of its findings. UR - https://www.i-jmr.org/2025/1/e56803 UR - http://dx.doi.org/10.2196/56803 ID - info:doi/10.2196/56803 ER - TY - JOUR AU - Luk, F. Luke Y. AU - Ching, Y. Christie J. AU - Yip, Fung Tsz AU - Chan, L. Sunny C. AU - Lam, T. Catherine Y. AU - Lam, C. Elizabeth T. AU - Yue, B. Serena R. AU - Pang, Ching Hoi AU - Wong, H. Janet Y. AU - Wong, H. Carlos K. AU - Tong, Kwan Chak AU - Yamamoto, Tafu AU - Rainer, H. Timothy AU - Wai, C. Abraham K. AU - Ho, K. Joshua W. PY - 2025/2/10 TI - Incidence of Deliberate Self-Harm in Hong Kong Before and During the COVID-19 Pandemic: Population-Wide Retrospective Cohort Study JO - JMIR Public Health Surveill SP - e57500 VL - 11 KW - emergency department KW - COVID-19 KW - deliberate self-harm KW - mental health KW - self-harm KW - self-injury KW - self-violence KW - Hong Kong KW - SARS-Cov-2 N2 - Background: COVID-19 ended on May 5, 2023, and since then Hong Kong reported increased mental distress, which was speculated to be from the policies implemented during the pandemic. Despite this, longitudinal surveillance of deliberate self-harm (DSH) incidences throughout the pandemic in Hong Kong remained insufficient. Objective: The objective of this study was to outline the changes in DSH incidences before and during the COVID-19 pandemic in Hong Kong, with respect to sex, age, and co-occurring mental health issues. Methods: A quasi-experiment was conducted using an interrupted time series design to estimate the impact of the pandemic on DSH-related emergency department (ED) visits. This design enabled the estimation of DSH-related ED visits based on prepandemic data from 2016 to 2019, assuming the pandemic had not occurred, and allowed for a comparison with observed DSH-related ED visits during the pandemic. The descriptive results were reported as the observed monthly DSH-related ED visits and observed incidence ratios during the pandemic. Afterwards, a negative binomial model was fitted to the prepandemic data (2016?2019) and adjusted for temporal trends, seasonality, and population variation to estimate the expected monthly DSH-related ED visits and adjusted incidence ratios (aIRs). Results: Between January 2016 and December 2022, a total of 31,893 DSH episodes were identified. Initial descriptive analysis showed a significant difference in demographic characteristics (sex) and clinical characteristics (death within 28 d, diagnoses of co-occurring mental health issues, public assistance pay code, and triage level). Subsequent interrupted time-series analysis demonstrated significantly increasing trends in comparison with the prepandemic period. As reported in the aIRs among young adult males (aIR in 2020=1.34, P=.002; 2021: aIR=1.94, P<.001; and 2022: aIR=2.53, P<.001), adult males (aIR in 2020=1.58, P<.001; 2021: aIR=2.64, P<.001; and 2022: aIR=3.13, P<.001), adult females (aIR in 2020=1.13, P=.01; 2021: aIR=1.52, P<.001; and 2022: aIR=1.64, P<.001), and older male adults (aIR in 2020=1.53, P<.001; 2021: aIR=2.37, P<.001; and 2022: aIR=3.01, P<.001). Conclusions: The average annual DSH-related ED visits increased during the pandemic period. Therefore, there is a need to raise awareness for such vulnerable groups in Hong Kong to prepare for postpandemic spillover. UR - https://publichealth.jmir.org/2025/1/e57500 UR - http://dx.doi.org/10.2196/57500 ID - info:doi/10.2196/57500 ER - TY - JOUR AU - Cui, Zixuan AU - Suo, Chen AU - Zhao, Yidan AU - Wang, Shuo AU - Zhao, Ming AU - Chen, Ruilin AU - Lu, Linyao AU - Zhang, Tiejun AU - Chen, Xingdong PY - 2025/1/29 TI - Spatiotemporal Correlation Analysis for the Incidence of Esophageal and Gastric Cancer From 2010 to 2019: Ecological Study JO - JMIR Cancer SP - e66655 VL - 11 KW - spatiotemporal analysis KW - spatiotemporal correlation KW - esophageal cancer KW - gastric cancer KW - cancer KW - global burden of disease KW - GBD KW - average annual percentage change KW - incidence KW - epidemiology N2 - Background: Esophageal and gastric cancer were among the top 10 most common cancers worldwide. In addition, sex-specific differences were observed in the incidence. Due to their anatomic proximity, the 2 cancers have both different but also shared risk factors and epidemiological features. Exploring the potential correlated incidence pattern of them, holds significant importance in providing clues in the etiology and preventive strategies. Objective: This study aims to explore the spatiotemporal correlation between the incidence patterns of esophageal and gastric cancer in 204 countries and territories from 2010 to 2019 so that prevention and control strategies can be more effective. Methods: The data of esophageal and gastric cancer were sourced from the Global Burden of Disease (GBD). Spatial autocorrelation analysis using Moran I in ArcGIS 10.8 (Esri) was performed to determine spatial clustering of each cancer incidence. We classified different risk areas based on the risk ratio (RR) of the 2 cancers in various countries to the global, and the correlation between their RR was evaluated using Pearson correlation coefficient. Temporal trends were quantified by calculating the average annual percent change (AAPC), and the correlation between the temporal trends of both cancers was evaluated using Pearson correlation coefficients. Results: In 2019, among 204 countries and territories, the age-standardized incidence rates (ASIR) of esophageal cancer ranged from 0.91 (95% CI 0.65-1.58) to 24.53 (95% CI 18.74-32.51), and the ASIR of gastric cancer ranged from 3.28 (95% CI 2.67-3.91) to 43.70 (95% CI 34.29-55.10). Malawi was identified as the highest risk for esophageal cancer (male RR=3.27; female RR=5.19) and low risk for gastric cancer (male RR=0.21; female RR=0.23) in both sexes. Spatial autocorrelation analysis revealed significant spatial clustering of the incidence for both cancers (Moran I>0.20 and P<.001). A positive correlation between the risk of esophageal and gastric cancer was observed in males (r=0.25, P<.001). The ASIR of both cancers showed a decreasing trend globally. The ASIR for esophageal and gastric cancer showed an AAPC of ?1.43 (95% CI ?1.58 to ?1.27) and ?1.76 (95% CI ?2.08 to ?1.43) in males, and ?1.93 (95% CI ?2.11 to ?1.75) and ?1.79 (95% CI ?2.13 to ?1.46) in females. In addition, a positive correlation between the temporal trends in ASIR for both cancers was observed at the global level across sexes (male r=0.98; female r=0.98). Conclusions: Our study shows that there was a significant spatial clustering of the incidence for esophageal and gastric cancer and a positive correlation between the risk of both cancers across countries was observed in males. In addition, a codescending incidence trend between both cancers was observed at the global level. UR - https://cancer.jmir.org/2025/1/e66655 UR - http://dx.doi.org/10.2196/66655 ID - info:doi/10.2196/66655 ER - TY - JOUR AU - Lin, Fu-Huang AU - Chou, Yu-Ching AU - Hsieh, Chi-Jeng AU - Yu, Chia-Peng PY - 2025/1/28 TI - Epidemiological Features, Clinical Symptoms, and Environmental Risk Factors for Notifiable Japanese Encephalitis in Taiwan From 2008 to 2020: Retrospective Study JO - JMIR Public Health Surveill SP - e63053 VL - 11 KW - epidemiology KW - Japanese encephalitis virus KW - domestic KW - environmental factor KW - retrospective study N2 - Background: Japanese encephalitis (JE) is a zoonotic parasitic disease caused by the Japanese encephalitis virus (JEV), and may cause fever, nausea, headache, or meningitis. It is currently unclear whether the epidemiological characteristics of the JEV have been affected by the extreme climatic conditions that have been observed in recent years. Objective: This study aimed to examine the epidemiological characteristics, trends, and potential risk factors of JE in Taiwan from 2008 to 2020. Specifically, the study focused on gender, age, season, residential area, clinical manifestations, high-risk areas, and the impact of environmental and climate factors. Methods: This study reviewed publicly available annual summary data on reported JE cases in the Taiwan Centers for Diseases Control between 2008 and 2020. Results: This study collected 309 confirmed domestic patients and 4 patients with imported JE. There was an increasing trend in the incidence of JE, 0.69?1.57 cases per 1,000,000 people, peaking in 2018. Case fatality rate was 7.7% (24/313). Comparing sex, age, season, and place of residence, the incidence rate was highest in males, 40? to 59-year-old patients, summer, and the Eastern region, with 1.89, 3.27, 1.25, and 12.2 cases per million people, respectively. The average coverage rate of the JE vaccine for children in Taiwan is 94.9%. Additionally, the major clinical manifestations of the cases included fever, unconsciousness, headache, stiff necks, psychological symptoms, vomiting, and meningitis. The major occurrence places of JE included paddy fields, pig farms, pigeon farms, poultry farms, and ponds. For air pollution factors, linear regression analysis showed that SO2 (ppb) concentration was positively associated with JE cases (?=2.184, P=.02), but O3 (ppb) concentration was negatively associated with them (?=?0.157, P=.01). For climate factors, relative humidity (%) was positively associated with JE cases (?=.380, P=.02). Conclusions: This study is the first to report confirmed cases of JE from the surveillance data of the Taiwan Centers for Diseases Control between 2008 and 2020. It identified residence, season, and age as risk factors for JE in Taiwan. Air pollution and climatic factors also influenced the rise in JE cases. This study confirmed that JE remains a prevalent infectious disease in Taiwan, with its epidemic gradually increasing in severity. These findings empower clinicians and health care providers to make informed decisions, guiding their care and resource allocation for patients with JE, a disease that significantly impacts the health and well-being of the Taiwanese population. UR - https://publichealth.jmir.org/2025/1/e63053 UR - http://dx.doi.org/10.2196/63053 ID - info:doi/10.2196/63053 ER - TY - JOUR AU - Khaksar, Sajjad AU - Jafari-Oori, Mehdi AU - Sarhangi, Forogh AU - Moayed, Sadat Malihe PY - 2025/1/28 TI - Pediatric Sleep Quality and Parental Stress in Neuromuscular Disorders: Descriptive Analytical Study JO - Asian Pac Isl Nurs J SP - e56667 VL - 9 KW - spinal muscular atrophy KW - neuromuscular disorders KW - sleep quality KW - pediatrics KW - parental stress KW - children KW - parents KW - muscular atrophy KW - muscular disorders N2 - Background: Neuromuscular disorders (NMDs) constitute a heterogeneous group of disorders that affect motor neurons, neuromuscular junctions, and muscle fibers, resulting in symptoms such as muscle weakness, fatigue, and reduced mobility. These conditions significantly affect patients? quality of life and impose a substantial burden on caregivers. Spinal muscular atrophy (SMA) is a relatively common NMD in children that presents in various types with varying degrees of severity. Objective: This study aimed to evaluate the sleep quality of children with NMDs, particularly SMA types 1, 2, and 3 and assess the stress levels experienced by their parents. Methods: A descriptive analytical study was conducted from February to October 2023, in selected hospitals and dystrophy associations in Tehran and Isfahan, Iran. A total of 207 children aged 1?14 years with various NMDs were included in the study. Data were collected using a web-based questionnaire with 3 parts: demographic information, the Children?s Sleep Habits Questionnaire to assess children?s sleep, and the Stress Response Inventory to measure parental stress. Statistical analyses were performed using SPSS version 22, with an ? level of .05. Results: Significant differences in sleep quality were found among SMA types, with mean scores of 74.76 (SD 7.48) for SMA type 1, 76.4 (SD 7.29) for SMA type 2, 72.88 (SD 6.73) for SMA type 3, and 75.87 (SD 5.74) for other NMDs (P=.02). A correlation was found between sleep and length of hospital stay (r=0.234, P<.001)and between sleep and the child?s sex (r=?0.140, P=.04). Parental stress scores averaged 95.73 (SD 32.12). There was not a statistically significant difference in parental stress scores among the 4 groups (P=.78). This suggests that parental stress levels were similar across different NMD groups. Conclusions: Sleep disorders are prevalent among children with NMDs, especially SMA. Parents experience high levels of stress that can affect the care they provide. Therefore, interventions to improve children?s sleep and address parental stress are crucial. Regular screening, counseling, and tailored support are recommended to enhance the well-being of children with NMDs and their families. UR - https://apinj.jmir.org/2025/1/e56667 UR - http://dx.doi.org/10.2196/56667 ID - info:doi/10.2196/56667 ER - TY - JOUR AU - Hoang, Uy AU - Agrawal, Utkarsh AU - Ordóñez-Mena, Manuel José AU - Marcum, Zachary AU - Radin, Jennifer AU - Araujo, Andre AU - Panozzo, A. Catherine AU - Balogh, Orsolya AU - Desai, Mihir AU - Eltayeb, Ahreej AU - Lu, Tianyi AU - Nicodemo, Catia AU - Gu, Xinchun AU - Goudie, Rosalind AU - Fan, Xuejuan AU - Button, Elizabeth AU - Smylie, Jessica AU - Joy, Mark AU - Jamie, Gavin AU - Elson, William AU - Byford, Rachel AU - Madia, Joan AU - Anand, Sneha AU - Ferreira, Filipa AU - Petrou, Stavros AU - Martin, David AU - de Lusignan, Simon PY - 2025/1/22 TI - Clinical Characteristics of Virologically Confirmed Respiratory Syncytial Virus in English Primary Care: Protocol for an Observational Study of Acute Respiratory Infection JO - JMIR Res Protoc SP - e60669 VL - 14 KW - infectious diseases KW - primary care KW - sentinel surveillance KW - point-of-care system KW - virologically KW - respiratory syncytial virus KW - acute respiratory infection KW - clinical characteristics KW - community dwelling KW - adult KW - vaccination KW - programme KW - united kingdom KW - incidence KW - elderly N2 - Background: There are gaps in our understanding of the clinical characteristics and disease burden of the respiratory syncytial virus (RSV) among community-dwelling adults. This is in part due to a lack of routine testing at the point of care. More data would enhance our assessment of the need for an RSV vaccination program for adults in the United Kingdom. Objective: This study aimed to implement point-of-care-testing (POCT) in primary care to describe the incidence, clinical presentation, risk factors, and economic burden of RSV among adults presenting with acute respiratory infection. Methods: We are recruiting up to 3600 patients from at least 21 practices across England to participate in the Royal College of General Practitioners Research Surveillance Centre. Practices are selected if they undertake reference virology sampling for the Royal College of General Practitioners Research Surveillance Centre and had previous experience with respiratory illness studies. Any adult, ?40 years old, presenting with acute respiratory infection with onset ?10 days, but without RSV within the past 28 days, will be eligible to participate. We will estimate the incidence proportion of RSV, describe the clinical features, and risk factors of patients with RSV infection, and measure the economic burden of RSV infection. Results: A total of 25 practices across different English health administrative regions expressed interest and were recruited to participate. We have created and tested an educational program to deploy POCT for RSV in primary care. In addition to using the POCT device, we provide suggestions about how to integrate POCT into primary care workflow and templates for high-quality data recording of diagnosis, symptoms, and signs. In the 2023-2024 winter RSV detection in the sentinel network grew between October and late November. According to data from the UK Health Security Agency, the peak RSV swab positivity was in International Standards Organization week 48, 2023. Data collection remains ongoing, and results from the subset of practices participating in this study are not yet available. Conclusions: This study will provide data on the RSV incidence in the community as well as rapid information to inform sentinel surveillance and vaccination programs. This information could potentially improve clinical decision-making. International Registered Report Identifier (IRRID): DERR1-10.2196/60669 UR - https://www.researchprotocols.org/2025/1/e60669 UR - http://dx.doi.org/10.2196/60669 UR - http://www.ncbi.nlm.nih.gov/pubmed/39841515 ID - info:doi/10.2196/60669 ER - TY - JOUR AU - Sasaki, Kenji AU - Ikeda, Yoichi AU - Nakano, Takashi PY - 2025/1/3 TI - Quantifying the Regional Disproportionality of COVID-19 Spread: Modeling Study JO - JMIR Form Res SP - e59230 VL - 9 KW - infectious disease KW - COVID-19 KW - epidemiology KW - public health KW - SARS-CoV-2 KW - pandemic KW - inequality measure KW - information theory KW - Kullback-Leibler divergence N2 - Background: The COVID-19 pandemic has caused serious health, economic, and social consequences worldwide. Understanding how infectious diseases spread can help mitigate these impacts. The Theil index, a measure of inequality rooted in information theory, is useful for identifying geographic disproportionality in COVID-19 incidence across regions. Objective: This study focused on capturing the degrees of regional disproportionality in incidence rates of infectious diseases over time. Using the Theil index, we aim to assess regional disproportionality in the spread of COVID-19 and detect epicenters where the number of infected individuals was disproportionately concentrated. Methods: To quantify the degree of disproportionality in the incidence rates, we applied the Theil index to the publicly available data of daily confirmed COVID-19 cases in the United States over a 1100-day period. This index measures relative disproportionality by comparing daily regional case distributions with population proportions, thereby identifying regions where infections are disproportionately concentrated. Results: Our analysis revealed a dynamic pattern of regional disproportionality in the confirmed cases by monitoring variations in regional contributions to the Theil index as the pandemic progressed. Over time, the index reflected a transition from localized outbreaks to widespread transmission, with high values corresponding to concentrated cases in some regions. We also found that the peaks in the Theil index often preceded surges in confirmed cases, suggesting its potential utility as an early warning signal. Conclusions: This study demonstrated that the Theil index is one of the effective indices for quantifying regional disproportionality in COVID-19 incidence rates. Although the Theil index alone cannot fully capture all aspects of pandemic dynamics, it serves as a valuable tool when used alongside other indicators such as infection and hospitalization rates. This approach allows policy makers to monitor regional disproportionality efficiently, offering insights for early intervention and targeted resource allocation. UR - https://formative.jmir.org/2025/1/e59230 UR - http://dx.doi.org/10.2196/59230 ID - info:doi/10.2196/59230 ER - TY - JOUR AU - Srithanaviboonchai, Kriengkrai AU - Yingyong, Thitipong AU - Tasaneeyapan, Theerawit AU - Suparak, Supaporn AU - Jantaramanee, Supiya AU - Roudreo, Benjawan AU - Tanpradech, Suvimon AU - Chuayen, Jarun AU - Kanphukiew, Apiratee AU - Naiwatanakul, Thananda AU - Aungkulanon, Suchunya AU - Martin, Michael AU - Yang, Chunfu AU - Parekh, Bharat AU - Northbrook, Chen Sanny PY - 2024/12/26 TI - Establishment, Implementation, Initial Outcomes, and Lessons Learned from Recent HIV Infection Surveillance Using a Rapid Test for Recent Infection Among Persons Newly Diagnosed With HIV in Thailand: Implementation Study JO - JMIR Public Health Surveill SP - e65124 VL - 10 KW - rapid test KW - surveillance KW - HIV KW - AIDS KW - diagnosis KW - Thailand KW - men who have sex with men KW - RITA KW - human immunodeficiency virus KW - acquired immune deficiency syndrome KW - transgender KW - recent infection testing algorithm N2 - Background: A recent infection testing algorithm (RITA) incorporating case surveillance (CS) with the rapid test for recent HIV infection (RTRI) was integrated into HIV testing services in Thailand as a small-scale pilot project in October 2020. Objective: We aimed to describe the lessons learned and initial outcomes obtained after the establishment of the nationwide recent HIV infection surveillance project from April through August 2022. Methods: We conducted desk reviews, developed a surveillance protocol and manual, selected sites, trained staff, implemented surveillance, and analyzed outcomes. Remnant blood specimens of consenting newly diagnosed individuals were tested using the Asanté HIV-1 Rapid Recency Assay. The duration of HIV infection was classified as RTRI-recent or RTRI-long-term. Individuals testing RTRI-recent with CD4 counts <200 cells/mm3 or those having opportunistic infections were classified as RITA-CS-long-term. Individuals testing RTRI-recent with CD4 counts >200 cells/mm3, no opportunistic infections, and not on antiretroviral treatment were classified as RITA-CS-recent. Results: Two hundred and one hospitals in 14 high-burden HIV provinces participated in the surveillance. Of these, 69 reported ?1 HIV diagnosis during the surveillance period. Of 1053 newly diagnosed cases, 64 (6.1%) were classified as RITA-CS-recent. On multivariate analysis, self-reporting as transgender women (adjusted odds ratio [AOR] 7.41, 95% CI 1.59?34.53) and men who have sex with men (AOR 2.59, 95% CI 1.02?6.56) compared to heterosexual men, and students compared to office workers or employers (AOR 3.76, 95% CI 1.25?11.35) were associated with RITA-CS-recent infection. The proper selection of surveillance sites, utilizing existing surveillance tools and systems, and conducting frequent follow-up and supervision visits were the most commonly cited lessons learned to inform the next surveillance phase. Conclusions: Recent HIV infection surveillance can provide an understanding of current epidemiologic trends to inform HIV prevention interventions to interrupt ongoing or recent HIV transmission. The key success factors of the HIV recent infection surveillance in Thailand include a thorough review of the existing HIV testing service delivery system, a streamlined workflow, strong laboratory and health services, and regular communication between sites and the Provincial Health Offices. UR - https://publichealth.jmir.org/2024/1/e65124 UR - http://dx.doi.org/10.2196/65124 ID - info:doi/10.2196/65124 ER - TY - JOUR AU - Wang, Yen-Chun AU - Jiesisibieke, Liduzi Zhu AU - Yang, Yu-Pei AU - Wang, Bing-Long AU - Hsiung, Ming-Chon AU - Tung, Tao-Hsin PY - 2024/12/24 TI - Disparities in the Prevalence of Urinary Diseases Among Prisoners in Taiwan: Population-Based Cross-Sectional Study JO - JMIR Public Health Surveill SP - e60136 VL - 10 KW - prisoners KW - Taiwan KW - health care KW - urinary disease KW - urinary tract infection KW - prison health N2 - Background: Prisoner health is a major global concern, with prisoners often facing limited access to health care and enduring chronic diseases, infectious diseases, and poor mental health due to unsafe prison environments, unhygienic living conditions, and inadequate medical resources. In Taiwan, prison health is increasingly an issue, particularly concerning urinary diseases such as urinary tract infections. Limited access to health care and unsanitary conditions exacerbate these problems. Urinary disease epidemiology varies by sex and age, yet studies in Asia are scarce, and comprehensive data on urinary diseases in Taiwanese prisons remain limited. Objective: This study aimed to investigate the prevalence of urinary diseases among Taiwanese prisoners and explore the differences in disease prevalence between men and women, as well as across different age groups. Methods: This study used data on prisoners from the National Health Insurance Research Database covering the period from January 1 to December 31, 2013. Prisoners covered by National Health Insurance who were diagnosed with urinary diseases, identified by ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) codes 580?599 based on their medical records, and had more than one medical visit to ambulatory care or inpatient services were included. Sex- and age-stratified analyses were conducted to determine the differences in the prevalence of urinary diseases. Results: We examined 83,048 prisoners, including 2998 with urinary diseases. The overall prevalence of urinary system diseases among prisoners was 3.61% (n=2998; n=574, 6.64% in men and n=2424, 3.26% in women). The prevalence rate in men was significantly lower than that in women (prevalence ratio: 0.46, P<.001). In age-stratified analysis, the prevalence rate among prisoners aged >40 years was 4.5% (n=1815), compared to 2.77% (n=1183) in prisoners aged ?40 years. Prisoners aged >40 years had a higher prevalence (prevalence ratio: 1.69, P<.001). Other disorders of the urethra and urinary tract (ICD-9-CM: 599), including urinary tract infection, urinary obstruction, and hematuria, were the most prevalent diseases of the urethra and urinary tract across age and sex groups. Women and older prisoners had a higher prevalence of most urinary tract diseases. There were no significant sex-specific differences in adjusted prevalence ratios for acute glomerulonephritis, nephrotic syndrome, kidney infections, urethritis (nonsexually transmitted), or urethral syndrome. However, based on the age-specific adjusted prevalence ratio analysis, cystitis was more prevalent among younger prisoners (prevalence ratio: 0.69, P=.004). Conclusions: Urinary system infections and inflammation are common in prisons. Our findings advocate for policy reforms aimed at improving health care accessibility in prisons, with a particular focus on the needs of high-risk groups such as women and older prisoners. Further research linking claims data with prisoner information is crucial to providing more comprehensive medical services and achieving health equity. UR - https://publichealth.jmir.org/2024/1/e60136 UR - http://dx.doi.org/10.2196/60136 ID - info:doi/10.2196/60136 ER - TY - JOUR AU - Shi, Ruizi AU - Jiang, Weisong AU - Yang, Jing AU - Dong, Xiaomei AU - Yu, Pei AU - Zhou, Shuai AU - Shang, Hanbing AU - Xu, Wanying AU - Chen, Er-zhen AU - Yang, Zhitao AU - Zhou, Ying PY - 2024/12/19 TI - Characteristics of In-Flight Medical Emergencies on a Commercial Airline in Mainland China: Retrospective Study JO - JMIR Public Health Surveill SP - e63557 VL - 10 KW - in-flight medical emergency KW - onboard emergency KW - aviation medicine KW - China KW - aircraft KW - medical emergency KW - aviation KW - airline KW - medical response KW - retrospective study N2 - Background: In-flight medical emergencies (IMEs) can have severe outcomes, including the deaths of passengers and aircraft diversions. Information is lacking regarding the incidence rate and characteristics of IMEs in most countries, especially in mainland China. Objective: The objective of this study was to investigate the incidence, patterns, and associated risk factors of IMEs in mainland China and to provide medical suggestions for the evaluation and management of IMEs. Methods: This population-based retrospective study examined electronic records for all IME reports between January 1, 2018, and December 31, 2022, from a major airline company in mainland China. Outcome variables included the medical category of the IMEs, the outcomes of first aid, and whether or not the IMEs led to a flight diversion. We calculated the incidence rate and death rate of IMEs based on the number of passengers and flights, respectively. A logistic regression model was used to investigate the factors associated with aircraft diversions. Results: A total of 199 IMEs and 24 deaths occurred among 447.2 million passengers, yielding an incidence rate of 0.44 (95% CI 0.39?0.51) events per million passengers and 66.56 (95% CI 50.55?86.04) events per million flights, and an all-cause mortality rate of 0.05 (95% CI 0.03?0.07) events per million passengers and 7.50 (95% CI 4.81?11.16) events per million flights. From 2018 to 2022, the highest incidence and mortality rates were observed in 2019 and 2020, respectively, while the lowest were in 2020 and 2021, respectively. Additionally, the highest incidence and mortality rates were observed between 6 PM to 6 AM and noon to 6 PM, respectively. There was a higher incidence rate of IMEs in the winter months. Moreover, the highest case-fatality rates were observed in 2019 (12/74, 16.2%), on flights traveling ?4000 km (9/43, 20.9%), and on wide-body planes (10/52, 19.2%). Seizures (29/199, 14.6%), cardiac symptoms (25/199, 12.6%), and syncope or presyncope (19/199, 9.6%) were the most common medical problems and main reasons for aircraft diversion. The incidence of aircraft diversion was 42.50 (95% CI 37.02?48.12) events per million flights. Narrow-body planes (odds ratio [OR] 5.69, 95% CI 1.05-30.90), flights ?4000 km (OR 16.40, 95% CI 1.78?151.29), and the months of December to February (OR 12.70, 95% CI 3.09?52.23), as well as the months of March to May (OR 23.21, 95% CI 3.75?143.43), were significantly associated with a higher risk of diversion. Conclusions: The occurrence of and deaths associated with IMEs are rare in mainland China, but a temporal trend shows higher incidence rates at night and in winter. The leading IMEs are cardiac symptoms, seizures, and syncope. The establishment of a unified reporting system for IMEs and ground-to-air medical support are of great value for reducing IMEs and deaths in the global community. UR - https://publichealth.jmir.org/2024/1/e63557 UR - http://dx.doi.org/10.2196/63557 ID - info:doi/10.2196/63557 ER - TY - JOUR AU - Lukmanjaya, Wilson AU - Butler, Tony AU - Taflan, Patricia AU - Simpson, Paul AU - Ginnivan, Natasha AU - Buchan, Iain AU - Nenadic, Goran AU - Karystianis, George PY - 2024/11/22 TI - Population Characteristics in Justice Health Research Based on PubMed Abstracts From 1963 to 2023: Text Mining Study JO - JMIR Form Res SP - e60878 VL - 8 KW - epidemiology KW - PubMed KW - criminology KW - text mining KW - justice health KW - offending and incarcerated populations KW - population characteristics KW - open research KW - health research KW - text mining study KW - epidemiological criminology KW - public health KW - justice systems KW - bias KW - population KW - men KW - women KW - prison KW - prisoner KW - researcher N2 - Background: The field of epidemiological criminology (or justice health research) has emerged in the past decade, studying the intersection between the public health and justice systems. To ensure research efforts are focused and equitable, it is important to reflect on the outputs in this area and address knowledge gaps. Objective: This study aimed to examine the characteristics of populations researched in a large sample of published outputs and identify research gaps and biases. Methods: A rule-based, text mining method was applied to 34,481 PubMed abstracts published from 1963 to 2023 to identify 4 population characteristics (sex, age, offender type, and nationality). Results: We evaluated our method in a random sample of 100 PubMed abstracts. Microprecision was 94.3%, with microrecall at 85.9% and micro?F1-score at 89.9% across the 4 characteristics. Half (n=17,039, 49.4%) of the 34,481 abstracts did not have any characteristic mentions and only 1.3% (n=443) reported sex, age, offender type, and nationality. From the 5170 (14.9%) abstracts that reported age, 3581 (69.3%) mentioned young people (younger than 18 years) and 3037 (58.7%) mentioned adults. Since 1990, studies reporting female-only populations increased, and in 2023, these accounted for almost half (105/216, 48.6%) of the research outputs, as opposed to 33.3% (72/216) for male-only populations. Nordic countries (Sweden, Norway, Finland, and Denmark) had the highest number of abstracts proportional to their incarcerated populations. Offenders with mental illness were the most common group of interest (840/4814, 17.4%), with an increase from 1990 onward. Conclusions: Research reporting on female populations increased, surpassing that involving male individuals, despite female individuals representing 5% of the incarcerated population; this suggests that male prisoners are underresearched. Although calls have been made for the justice health area to focus more on young people, our results showed that among the abstracts reporting age, most mentioned a population aged <18 years, reflecting a rise of youth involvement in the youth justice system. Those convicted of sex offenses and crimes relating to children were not as researched as the existing literature suggests, with a focus instead on populations with mental illness, whose rates rose steadily in the last 30 years. After adjusting for the size of the incarcerated population, Nordic countries have conducted proportionately the most research. Our findings highlight that despite the presence of several research reporting guidelines, justice health abstracts still do not adequately describe the investigated populations. Our study offers new insights in the field of justice health with implications for promoting diversity in the selection of research participants. UR - https://formative.jmir.org/2024/1/e60878 UR - http://dx.doi.org/10.2196/60878 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60878 ER - TY - JOUR AU - Leandro, André AU - Maciel-de-Freitas, Rafael PY - 2024/11/14 TI - Development of an Integrated Surveillance System to Improve Preparedness for Arbovirus Outbreaks in a Dengue Endemic Setting: Descriptive Study JO - JMIR Public Health Surveill SP - e62759 VL - 10 KW - surveillance KW - Aedes aegypti KW - vector control KW - transmission risk KW - dengue fever N2 - Background: Dengue fever, transmitted by Aedes aegypti and Aedes albopictus mosquitoes, poses a significant public health challenge in tropical and subtropical regions. Dengue surveillance involves monitoring the incidence, distribution, and trends of infections through systematic data collection, analysis, interpretation, and dissemination. It supports public health decision-making, guiding interventions like vector control, vaccination campaigns, and public education. Objective: Herein, we report the development of a surveillance system already in use to support public health managers against dengue transmission in Foz do Iguaçu, a dengue-endemic Brazilian city located in the Triple Border with Argentina and Paraguay. Methods: We present data encompassing the fieldwork organization of more than 100 health agents; epidemiological and entomological data were gathered from November 2022 to April 2024, totalizing 18 months of data collection. Results: By registering health agents, we were able to provide support for those facing issues to fill their daily milestone of inspecting 16 traps per working day. We filtered dengue transmission in the city by patient age, gender, and reporting units, as well as according to dengue virus serotype. The entomological indices presented a strong seasonal pattern, as expected. Several longtime established routines in Foz do Iguaçu have been directly impacted by the adoption of Vigilância Integrada com Tecnologia (VITEC). Conclusions: The implementation of VITEC has enabled more efficient and accurate diagnostics of local transmission risk, leading to a better understanding of operational activity patterns and risks. Lately, local public health managers can easily identify hot spots of dengue transmission and optimize interventions toward those highly sensitive areas. UR - https://publichealth.jmir.org/2024/1/e62759 UR - http://dx.doi.org/10.2196/62759 ID - info:doi/10.2196/62759 ER - TY - JOUR AU - Qureshi, Nabeel AU - Hays, D. Ron AU - Herman, M. Patricia PY - 2024/11/11 TI - Dropout in a Longitudinal Survey of Amazon Mechanical Turk Workers With Low Back Pain: Observational Study JO - Interact J Med Res SP - e58771 VL - 13 KW - chronic low back pain KW - Mechanical Turk KW - MTurk KW - survey attrition KW - survey weights KW - Amazon KW - occupational health KW - manual labor N2 - Background: Surveys of internet panels such as Amazon?s Mechanical Turk (MTurk) are common in health research. Nonresponse in longitudinal studies can limit inferences about change over time. Objective: This study aimed to (1) describe the patterns of survey responses and nonresponse among MTurk members with back pain, (2) identify factors associated with survey response over time, (3) assess the impact of nonresponse on sample characteristics, and (4) assess how well inverse probability weighting can account for differences in sample composition. Methods: We surveyed adult MTurk workers who identified as having back pain. We report participation trends over 3 survey waves and use stepwise logistic regression to identify factors related to survey participation in successive waves. Results: A total of 1678 adults participated in wave 1. Of those, 983 (59%) participated in wave 2 and 703 (42%) in wave 3. Participants who did not drop out took less time to complete previous surveys (30 min vs 35 min in wave 1, P<.001; 24 min vs 26 min in wave 2, P=.02) and reported having fewer health conditions (5.88 vs 6.6, P<.001). In multivariate models predicting responding at wave 2, lower odds of participation were associated with more time to complete the baseline survey (odds ratio [OR] 0.98, 95% CI 0.97-0.99), being Hispanic (compared with non-Hispanic, OR 0.69, 95% CI 0.49-0.96), having a bachelor?s degree as their terminal degree (compared with all other levels of education, OR 0.58, 95% CI 0.46-0.73), having more pain interference and intensity (OR 0.75, 95% CI 0.64-0.89), and having more health conditions. In contrast, older respondents (older than 45 years age compared with 18-24 years age) were more likely to respond to the wave 2 survey (OR 2.63 and 3.79, respectively) and those whose marital status was divorced (OR 1.81) and separated (OR 1.77) were also more likely to respond to the wave 2 survey. Weighted analysis showed slight differences in sample demographics and conditions and larger differences in pain assessments, particularly for those who responded to wave 2. Conclusions: Longitudinal studies on MTurk have large, differential dropouts between waves. This study provided information about the individuals more likely to drop out over time, which can help researchers prepare for future surveys. UR - https://www.i-jmr.org/2024/1/e58771 UR - http://dx.doi.org/10.2196/58771 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58771 ER - TY - JOUR AU - Park, Seoyoung AU - Son, Yejun AU - Lee, Hyeri AU - Lee, Hayeon AU - Lee, Jinseok AU - Kang, Jiseung AU - Smith, Lee AU - Rahmati, Masoud AU - Dragioti, Elena AU - Tully, A. Mark AU - Fond, Guillaume AU - Boyer, Laurent AU - Lee, Hyuk Jun AU - Pizzol, Damiano AU - Park, Jaeyu AU - Woo, Selin AU - Yon, Keon Dong PY - 2024/11/1 TI - Sex-Specific Trends in the Prevalence of Osteoarthritis and Rheumatoid Arthritis From 2005 to 2021 in South Korea: Nationwide Cross-Sectional Study JO - JMIR Public Health Surveill SP - e57359 VL - 10 KW - epidemiology KW - osteoarthritis KW - rheumatoid arthritis KW - South Korea KW - trend N2 - Background: Osteoarthritis and rheumatoid arthritis (RA) are prevalent chronic joint disorders, with prevalence rates varying by sex. However, few studies have comprehensively documented the factors contributing to the sex-specific prevalence of osteoarthritis and RA, including sociological factors and the impact of the COVID-19 pandemic. Objective: This study aims to identify long-term trends in the sex-specific prevalence of osteoarthritis and RA from 2005 to 2021 while examining the factors that serve as vulnerabilities specific to each sex within the context of the COVID-19 pandemic. Methods: Data were collected from a nationally representative sample of 110,225 individuals through the Korea National Health and Nutrition Examination Survey from 2005 to 2021. The study included patients aged 19 years and older diagnosed with osteoarthritis or RA in South Korea. Data were analyzed using weighted trends to accurately represent the sample population, with a 95% CI. Weighted logistic and regression models were used to identify vulnerable groups at risk of osteoarthritis or RA during the pandemic to assess sex-specific trends. Results: In total, 110,225 individuals (n=48,410, 43.92% male participants) were analyzed from 2005 to 2021, with prevalence rates remaining stable over time and higher in female than in male participants. Notably, during the pandemic, female participants aged 60 years and older exhibited a prevalence of osteoarthritis that was 4.92 times greater than male participants and a prevalence of RA that was 6.44 times greater (osteoarthritis: prevalence ratio [PR] 69.78, 95% CI 41.66-116.88; RA: PR 17.27, 95% CI 8.75-34.07). In terms of osteoarthritis, male participants did not show a significant association with BMI (PR 1.40, 95% CI 1.21-1.61; P=.47), whereas female participants exhibited a significantly higher vulnerability within the obese group (PR 1.68, 95% CI 1.55-1.83; P<.001). Regarding RA, lower education levels were associated with increased vulnerability, with male participants showing a greater risk than female participants (male participants: PR 2.29, 95% CI 1.61-3.27 and female participants: PR 1.50, 95% CI 1.23-1.84). Conclusions: This study reveals that women in South Korea have a higher prevalence of osteoarthritis and RA than men. Understanding these sex-specific trends and identifying vulnerability factors can enhance preventive efforts and patient care. UR - https://publichealth.jmir.org/2024/1/e57359 UR - http://dx.doi.org/10.2196/57359 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57359 ER - TY - JOUR AU - Mubarik, Sumaira AU - Naeem, Shafaq AU - Shen, Hui AU - Mubarak, Rabia AU - Luo, Lisha AU - Hussain, Rija Syeda AU - Hak, Eelko AU - Yu, Chuanhua AU - Liu, Xiaoxue PY - 2024/10/17 TI - Population-Level Distribution, Risk Factors, and Burden of Mortality and Disability-Adjusted Life Years Attributable to Major Noncommunicable Diseases in Western Europe (1990-2021): Ecological Analysis JO - JMIR Public Health Surveill SP - e57840 VL - 10 KW - mortality KW - smoking KW - Western Europe KW - CVDs KW - cardiovascular disease KW - HDI KW - Human Development Index KW - neoplasms KW - cancer KW - DALYs KW - disability-adjusted life years N2 - Background: Cardiovascular diseases (CVDs) and neoplasms are leading causes of mortality worldwide. Objective: This study aims to provide a comprehensive analysis of the mortality burden and disability-adjusted life years (DALYs) attributable to CVDs and neoplasms in Western Europe, investigate associated risk factors, and identify regional disparities. Additionally, the study evaluates the effectiveness of the Action Plan for the Prevention and Control of Non-Communicable Diseases (NCDs) in promoting healthier lives in the region. Methods: The study collected data on mortality and DALYs due to CVDs and cancers from 24 Western European countries using the Global Burden of Disease Study 2021. The analysis explored age, sex, and country-specific patterns, as well as risk factors contributing to these deaths. Additionally, the study examined time trends by calculating the annual percent change in mortality rates from 1990 to 2021 by region and cause. Results: In 2021, CVDs and neoplasms accounted for 27.8% and 27.1% of total deaths in Western Europe, with age-standardized death rates of 106.8 and 125.8 per 100,000, respectively. The top two CVDs in this region were ischemic heart disease and stroke, with age-standardized death rates of 47.27 (95% uncertainty interval [UI] 50.42-41.45) and 27.06 (95% UI 29.17-23.00), respectively. Similarly, the top two neoplasms were lung cancer and colorectal cancer, with age-standardized death rates of 26.4 (95% UI 27.69-24.47) and 15.1 (95% UI 16.25-13.53), respectively. Between 1990 and 2021, CVD mortality rates decreased by 61.9%, while cancer rates decreased by 28.27%. Finland had the highest CVD burden (39.5%), and Monaco had the highest rate of cancer-related deaths (34.8%). Gender differences were observed, with males experiencing a higher burden of both CVDs and cancer. Older individuals were also more at risk. Smoking had a stronger impact on CVD mortality and DALYs in males, while a higher Human Development Index was associated with increased cancer deaths and DALYs in females. Conclusions: The study findings highlight the substantial burden of NCDs, particularly CVDs and cancer, in Western Europe. This underscores the critical need for targeted interventions and effective implementation of the Action Plan for the Prevention and Control of NCDs to achieve the goal of ensuring healthy lives for all. UR - https://publichealth.jmir.org/2024/1/e57840 UR - http://dx.doi.org/10.2196/57840 ID - info:doi/10.2196/57840 ER - TY - JOUR AU - Ruksakulpiwat, Suebsarn AU - Niyomyart, Atsadaporn AU - Riangkam, Chontira AU - Phianhasin, Lalipat AU - Benjasirisan, Chitchanok AU - Adams, Jon PY - 2024/10/15 TI - Exploring the Linkages Among Chronic Illness, Substance Use, and COVID-19 Infection in Adults Aged 50 Years and Older: Retrospective Cross-Sectional Analysis of National Representative Data JO - JMIR Aging SP - e63024 VL - 7 KW - multiple chronic conditions KW - medical complexity KW - co-occurring conditions KW - substance use KW - COVID-19 KW - SARS-CoV-2 KW - older adults KW - gerontology KW - geriatrics N2 - Background: The co-occurrence of chronic illnesses and substance use presents complex challenges for health care systems. Understanding the interplay between these factors, compounded by the context of the COVID-19 pandemic, is essential for effective intervention strategies. Objective: This study aims to investigate the relationships among chronic illness, substance use, and COVID-19 infection in adults aged 50 years and older. Methods: Participants were 1196 adults aged 50 years and older. Descriptive statistics were used to describe demographic information. Logistic regressions and multiple regression analyses were used to determine associations between chronic illnesses, substance use, and COVID-19 infection. Mediation analysis was used to determine the effect of chronic illness mediators in the association between COVID-19 concerns and substance use. Results: The mean age was 68 (SD 10.3) years, with 58.6% (701/1196) being women. Adjusted analysis revealed that age and sex (women) significantly predicted a lower level of substance use (P<.05). However, marital status (separated or widowed) and chronic illness significantly predicted a higher level of substance use (P<.05). Furthermore, having dementia, arthritis, and high cholesterol significantly predicted a higher level of concern about the COVID-19 pandemic (P<.05). Logistic regression analysis indicated that individuals with hypertension (odds ratio [OR] 1.91, 95% CI 1.37-2.66; P<.001), lung disease (OR 2.42, 95% CI 1.23-4.75; P=.01), heart condition (OR 1.99, 95% CI 1.28-3.10; P=.002), stroke (OR 2.35, 95% CI 1.07-5.16; P=.03), and arthritis (OR 1.72, 95% CI 1.25-2.37; P=.001) were more likely to have their work affected by the COVID-19 pandemic. The mediation analysis showed a significant effect of COVID-19 concern on substance use through the mediation of chronic illness, with a 95% CI of ?0.02 to ?0.01 and an indirect effect of ?0.01. Conclusions: Our study reveals complex associations among chronic illnesses, substance use, and COVID-19 infection among adults aged 50 years and older. It underscores the impact of demographics and specific chronic conditions on substance use behaviors and COVID-19 concerns. In addition, certain chronic illnesses were linked to heightened vulnerability in employment status during the pandemic. These findings emphasize the need for targeted interventions addressing physical health and substance use in this population during the COVID-19 pandemic. UR - https://aging.jmir.org/2024/1/e63024 UR - http://dx.doi.org/10.2196/63024 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63024 ER - TY - JOUR AU - Conderino, Sarah AU - Anthopolos, Rebecca AU - Albrecht, S. Sandra AU - Farley, M. Shannon AU - Divers, Jasmin AU - Titus, R. Andrea AU - Thorpe, E. Lorna PY - 2024/10/1 TI - Addressing Information Biases Within Electronic Health Record Data to Improve the Examination of Epidemiologic Associations With Diabetes Prevalence Among Young Adults: Cross-Sectional Study JO - JMIR Med Inform SP - e58085 VL - 12 KW - information bias KW - electronic health record KW - EHR KW - epidemiologic method KW - confounding factor KW - diabetes KW - epidemiology KW - young adult KW - cross-sectional study KW - risk factor KW - asthma KW - race KW - ethnicity KW - diabetic KW - diabetic adult N2 - Background: Electronic health records (EHRs) are increasingly used for epidemiologic research to advance public health practice. However, key variables are susceptible to missing data or misclassification within EHRs, including demographic information or disease status, which could affect the estimation of disease prevalence or risk factor associations. Objective: In this paper, we applied methods from the literature on missing data and causal inference to assess whether we could mitigate information biases when estimating measures of association between potential risk factors and diabetes among a patient population of New York City young adults. Methods: We estimated the odds ratio (OR) for diabetes by race or ethnicity and asthma status using EHR data from NYU Langone Health. Methods from the missing data and causal inference literature were then applied to assess the ability to control for misclassification of health outcomes in the EHR data. We compared EHR-based associations with associations observed from 2 national health surveys, the Behavioral Risk Factor Surveillance System (BRFSS) and the National Health and Nutrition Examination Survey, representing traditional public health surveillance systems. Results: Observed EHR-based associations between race or ethnicity and diabetes were comparable to health survey-based estimates, but the association between asthma and diabetes was significantly overestimated (OREHR 3.01, 95% CI 2.86-3.18 vs ORBRFSS 1.23, 95% CI 1.09-1.40). Missing data and causal inference methods reduced information biases in these estimates, yielding relative differences from traditional estimates below 50% (ORMissingData 1.79, 95% CI 1.67-1.92 and ORCausal 1.42, 95% CI 1.34-1.51). Conclusions: Findings suggest that without bias adjustment, EHR analyses may yield biased measures of association, driven in part by subgroup differences in health care use. However, applying missing data or causal inference frameworks can help control for and, importantly, characterize residual information biases in these estimates. UR - https://medinform.jmir.org/2024/1/e58085 UR - http://dx.doi.org/10.2196/58085 ID - info:doi/10.2196/58085 ER - TY - JOUR AU - Hirschtick, L. Jana AU - Slocum, Elizabeth AU - Xie, Yanmei AU - Power, E. Laura AU - Elliott, R. Michael AU - Orellana, C. Robert AU - Fleischer, L. Nancy PY - 2024/10/1 TI - Associations Between Acute COVID-19 Symptom Profiles and Long COVID Prevalence: Population-Based Cross-Sectional Study JO - JMIR Public Health Surveill SP - e55697 VL - 10 KW - SARS-CoV-2 KW - COVID-19 KW - post-acute COVID-19 syndrome KW - epidemiology KW - surveillance N2 - Background: Growing evidence suggests that severe acute COVID-19 illness increases the risk of long COVID (also known as post?COVID-19 condition). However, few studies have examined associations between acute symptoms and long COVID onset. Objective: This study aimed to examine associations between acute COVID-19 symptom profiles and long COVID prevalence using a population-based sample. Methods: We used a dual mode (phone and web-based) population-based probability survey of adults with polymerase chain reaction?confirmed SARS-CoV-2 between June 2020 and May 2022 in the Michigan Disease Surveillance System to examine (1) how acute COVID-19 symptoms cluster together using latent class analysis, (2) sociodemographic and clinical predictors of symptom clusters using multinomial logistic regression accounting for classification uncertainties, and (3) associations between symptom clusters and long COVID prevalence using modified Poisson regression. Results: In our sample (n=4169), 15.9% (n=693) had long COVID, defined as new or worsening symptoms at least 90 days post SARS-CoV-2 infection. We identified 6 acute COVID-19 symptom clusters resulting from the latent class analysis, with flu-like symptoms (24.7%) and fever (23.6%) being the most prevalent in our sample, followed by nasal congestion (16.4%), multi-symptomatic (14.5%), predominance of fatigue (10.8%), and predominance of shortness of breath (10%) clusters. Long COVID prevalence was highest in the multi-symptomatic (39.7%) and predominance of shortness of breath (22.4%) clusters, followed by the flu-like symptom (15.8%), predominance of fatigue (14.5%), fever (6.4%), and nasal congestion (5.6%) clusters. After adjustment, females (vs males) had greater odds of membership in the multi-symptomatic, flu-like symptom, and predominance of fatigue clusters, while adults who were Hispanic or another race or ethnicity (vs non-Hispanic White) had greater odds of membership in the multi-symptomatic cluster. Compared with the nasal congestion cluster, the multi-symptomatic cluster had the highest prevalence of long COVID (adjusted prevalence ratio [aPR] 6.1, 95% CI 4.3?8.7), followed by the predominance of shortness of breath (aPR 3.7, 95% CI 2.5?5.5), flu-like symptom (aPR 2.8, 95% CI 1.9?4.0), and predominance of fatigue (aPR 2.2, 95% CI 1.5?3.3) clusters. Conclusions: Researchers and clinicians should consider acute COVID-19 symptom profiles when evaluating subsequent risk of long COVID, including potential mechanistic pathways in a research context, and proactively screen high-risk patients during the provision of clinical care. UR - https://publichealth.jmir.org/2024/1/e55697 UR - http://dx.doi.org/10.2196/55697 ID - info:doi/10.2196/55697 ER - TY - JOUR AU - Wang, Ying AU - Wang, Zhuohao AU - Jiang, Jie AU - Guo, Tong AU - Chen, Shimin AU - Li, Zhiqiang AU - Yuan, Zhupei AU - Lin, Qiaoxuan AU - Du, Zhicheng AU - Wei, Jing AU - Hao, Yuantao AU - Zhang, Wangjian PY - 2024/9/24 TI - The Effect of Long-Term Particulate Matter Exposure on Respiratory Mortality: Cohort Study in China JO - JMIR Public Health Surveill SP - e56059 VL - 10 KW - respiratory disease KW - mortality KW - particulate matter KW - causal inference KW - cohort study N2 - 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-?g/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. UR - https://publichealth.jmir.org/2024/1/e56059 UR - http://dx.doi.org/10.2196/56059 ID - info:doi/10.2196/56059 ER - TY - JOUR AU - Kong, Deliang AU - Wu, Chengguo AU - Cui, Yimin AU - Fan, Jun AU - Zhang, Ting AU - Zhong, Jiyuan AU - Pu, Chuan PY - 2024/9/24 TI - Epidemiological Characteristics and Spatiotemporal Clustering of Pulmonary Tuberculosis Among Students in Southwest China From 2016 to 2022: Analysis of Population-Based Surveillance Data JO - JMIR Public Health Surveill SP - e64286 VL - 10 KW - student PTB KW - Southwest China KW - epidemiology KW - visualizing incidence map KW - spatial autocorrelation analysis KW - spatiotemporal clusters KW - pulmonary tuberculosis N2 - Background: Pulmonary tuberculosis (PTB), as a respiratory infectious disease, poses significant risks of covert transmission and dissemination. The high aggregation and close contact among students in Chinese schools exacerbate the transmission risk of PTB outbreaks. Objective: This study investigated the epidemiological characteristics, geographic distribution, and spatiotemporal evolution of student PTB in Chongqing, Southwest China, aiming to delineate the incidence risks and clustering patterns of PTB among students. Methods: PTB case data from students monitored and reported in the Tuberculosis Information Management System within the China Information System for Disease Control and Prevention were used for this study. Descriptive analyses were conducted to characterize the epidemiological features of student PTB. Spatial trend surface analysis, global and local spatial autocorrelation analyses, and disease rate mapping were performed using ArcGIS 10.3. SaTScan 9.6 software was used to identify spatiotemporal clusters of PTB cases. Results: From 2016 to 2022, a total of 9920 student TB cases were reported in Chongqing, Southwest China, with an average incidence rate of 24.89/100,000. The incidence of student TB showed an initial increase followed by a decline, yet it remained relatively high. High school students (age: 13?18 years; 6649/9920, 67.03%) and college students (age: ?19 years; 2921/9920, 29.45%) accounted for the majority of student PTB cases. Patient identification primarily relied on passive detection, with a high proportion of delayed diagnosis and positive etiological results. COVID-19 prevention measures have had some impact on reducing incidence levels, but the primary factor appears to be the implementation of screening measures, which facilitated earlier case detection. Global spatial autocorrelation analysis indicated Moran I values of >0 for all years except 2018, ranging from 0.1908 to 0.4645 (all P values were <.05), suggesting strong positive spatial clustering of student PTB cases across Chongqing. Local spatial autocorrelation identified 7 high-high clusters, 13 low-low clusters, 5 high-low clusters, and 4 low-high clusters. High-high clusters were predominantly located in the southeast and northeast parts of Chongqing, consistent with spatial trend surface analysis and spatiotemporal clustering results. Spatiotemporal scan analysis revealed 4 statistically significant spatiotemporal clusters, with the most likely cluster in the southeast (relative risk [RR]=2.87, log likelihood ratio [LLR]=574.29, P<.001) and a secondary cluster in the northeast (RR=1.99, LLR=234.67, P<.001), indicating higher reported student TB cases and elevated risks of epidemic spread within these regions. Conclusions: Future efforts should comprehensively enhance prevention and control measures in high-risk areas of PTB in Chongqing to mitigate the incidence risk among students. Additionally, implementing proactive screening strategies and enhancing screening measures are crucial for early identification of student patients to prevent PTB outbreaks in schools. UR - https://publichealth.jmir.org/2024/1/e64286 UR - http://dx.doi.org/10.2196/64286 ID - info:doi/10.2196/64286 ER - TY - JOUR AU - Wang, Xiaoling AU - Rao, Rui AU - Li, Hua AU - Lei, Xiaoping AU - Dong, Wenbin PY - 2024/9/18 TI - Red Blood Cell Transfusion for Incidence of Retinopathy of Prematurity: Prospective Multicenter Cohort Study JO - JMIR Pediatr Parent SP - e60330 VL - 7 KW - red blood cell transfusion KW - retinopathy of prematurity KW - VPI KW - very preterm infants KW - ROP KW - visual impairment KW - blindness KW - RBC KW - red blood cell N2 - Background: Retinopathy of prematurity (ROP) is a leading cause of visual impairment and blindness in preterm infants. Objective: This study sought to investigate the association between red blood cell (RBC) transfusion and ROP in very preterm infants (VPIs) to inform clinical strategies for ROP prevention and treatment. Methods: We designed a prospective multicenter cohort study that included VPIs and follow-up data from January 2017 to December 2022 at 3 neonatal clinical medicine centers. They were categorized into a transfusion group (infants who received an RBC transfusion within 4 wk) and a nontransfusion group. The relationship between RBC transfusion and ROP incidence was assessed using binary logistic regression, with subgroup analyses based on gestational age, birth weight, sex, and sepsis status. Inverse probability of treatment weighting and propensity score matching were applied to account for all potential confounding factors that could affect ROP development, followed by sensitivity analysis. Results: The study included 832 VPIs, including 327 in the nontransfusion group and 505 in the transfusion group. The transfusion group had a lower average birth weight and gestational age and a greater incidence of ROP, ?stage 2 ROP, and severe ROP. Logistic regression analysis revealed that the transfusion group had a significantly greater risk of ROP (adjusted odds ratio [aOR] 1.70, 95% CI 1.14?2.53, P=.009) and ?stage 2 ROP (aOR 1.68, 95% CI 1.02?2.78, P=.04) but not severe ROP (aOR 1.75, 95% CI 0.61?5.02, P=.30). The trend analysis also revealed an increased risk of ROP with an increasing number of transfusions and a larger volume of blood transfused (P for trend<.001). Subgroup analyses confirmed a consistent trend, with the transfusion group at a higher risk for ROP across all subgroups. Inverse probability of treatment weighting and propensity score matching analyses supported the initial findings. Conclusions: For VPIs, RBC transfusion significantly increases the risk of ROP, and the risk increases with an increasing number of transfusions and volume of blood transfused. UR - https://pediatrics.jmir.org/2024/1/e60330 UR - http://dx.doi.org/10.2196/60330 ID - info:doi/10.2196/60330 ER - TY - JOUR AU - Liu, Fang-Chen AU - Chen, Bao-Chung AU - Huang, Yao-Ching AU - Huang, Shi-Hao AU - Chung, Jei Ren AU - Yu, Pi-Ching AU - Yu, Chia-Peng PY - 2024/9/5 TI - Epidemiological Survey of Enterovirus Infections in Taiwan From 2011 to 2020: Retrospective Study JO - JMIR Public Health Surveill SP - e59449 VL - 10 KW - epidemiology KW - enterovirus KW - domestic KW - cluster KW - sporadic KW - retrospective KW - Taiwan N2 - Background: Young children are susceptible to enterovirus (EV) infections, which cause significant morbidity in this age group. Objective: This study investigated the characteristics of virus strains and the epidemiology of EVs circulating among young children in Taiwan from 2011 to 2020. Methods: Children diagnosed with EV infections from 2011 to 2020 were identified from the routine national health insurance data monitoring disease system, real-time outbreak and disease surveillance system, national laboratory surveillance system, and Statistics of Communicable Diseases and Surveillance Report, a data set (secondary data) of the Taiwan Centers for Disease and Control. Four primary outcomes were identified: epidemic features, characteristics of sporadic and cluster cases of EV infections, and main cluster institutions. Results: From 2011 to 2020, between 10 and 7600 person-times visited the hospitals for EV infections on an outpatient basis daily. Based on 2011 to 2020 emergency department EV infection surveillance data, the permillage of EV visits throughout the year ranged from 0.07? and 25.45?. After typing by immunofluorescence assays, the dominant type was coxsackie A virus (CVA; 8844/12,829, 68.9%), with most constituting types CVA10 (n=2972), CVA2 (n=1404), CVA6 (n=1308), CVA4 (n=1243), CVA16 (n=875), and CVA5 (n=680); coxsackie B virus CVB (n=819); echovirus (n=508); EV-A71 (n=1694); and EV-D68 (n=10). There were statistically significant differences (P<.001) in case numbers of EV infections among EV strains from 2011 to 2020. Cases in 2012 had 15.088 times the odds of being EV-A71, cases in 2014 had 2.103 times the odds of being CVA, cases in 2015 had 1.569 times the odds of being echovirus, and cases in 2018 had 2.274 times the odds of being CVB as cases in other years. From 2011 to 2020, in an epidemic analysis of EV clusters, 57 EV clusters were reported. Clusters that tested positive included 53 (53/57, 93%) CVA cases (the major causes were CVA6, n=32, and CVA10, n=8). Populous institutions had the highest proportion (7 of 10) of EV clusters. Conclusion: This study is the first report of sporadic and cluster cases of EV infections from surveillance data (Taiwan Centers for Disease and Control, 2011?2020). This information will be useful for policy makers and clinical experts to direct prevention and control activities to EV infections that cause the most severe illness and greatest burden to the Taiwanese. UR - https://publichealth.jmir.org/2024/1/e59449 UR - http://dx.doi.org/10.2196/59449 ID - info:doi/10.2196/59449 ER - TY - JOUR AU - Liu, Bowen AU - Zhang, Tao AU - Wang, Duoquan AU - Xia, Shang AU - Li, Weidong AU - Zhang, Xiaoxi AU - Wang, Shuxun AU - Guo, Xiao-Kui AU - Zhou, Xiao-Nong AU - Li, Shizhu PY - 2024/8/30 TI - Profile and Determinants for Complications of Imported Malaria in 5 Chinese Provinces From 2014 to 2021: Retrospective Analysis JO - JMIR Public Health Surveill SP - e52089 VL - 10 KW - imported malaria KW - epidemiological characteristics KW - complications KW - influencing factors KW - China N2 - Background: In 2021, the World Health Organization officially declared the People?s Republic of China as malaria-free. However, despite this milestone achievement, the continued occurrence of severe and fatal cases of imported malaria in China, due to globalization and increased international communication, remains a significant public health concern. Objective: The aim of this study was to elucidate the epidemiological characteristics of imported malaria in 5 Chinese provinces from 2014 to 2021 and to identify the factors that influence complications in imported malaria cases. The findings will provide a basis for enhancing prevention and control measures, thereby consolidating China?s achievements in malaria elimination. Methods: A case-based retrospective study was performed, using surveillance data collected from the representative provinces of China from 2014 to 2021. Epidemiological characteristics were analyzed using descriptive statistics. Logistic regression was used to identify the factors influencing the occurrence of complications. Results: A total of 5559 malaria cases were included during the study period. The predominant species was Plasmodium falciparum (3940/5559, 70.9%), followed by Plasmodium ovale (1054/5559, 19%), Plasmodium vivax (407/5559, 7.3%), Plasmodium malariae (157/5559, 2.8%), and 1 case of Plasmodium knowlesi. Most of the cases were male (5343/5559, 96.1%). The complication rates for P falciparum and P ovale were 11.4% and 3.3%, respectively. Multivariate logistic regression analysis of the relevant factors of malaria complications revealed potential protective factors, including a previous infection by Plasmodium (P<.001; odds ratio [OR] 0.512, 95% CI 0.422?0.621), and risk factors, including increased age (P=.004; OR 1.014, 95% CI 1.004?1.024), misdiagnosis at the first clinical visit (P<.001; OR 3.553, 95% CI 2.886?4.375), and the time interval from onset to treatment (P=.001; OR 1.026, 95% CI 1.011?1.042). Subgroup analyses identified risk factors associated with P falciparum, which include advanced age (P=.004; OR 1.015, 95% CI 1.005?1.026), initial misdiagnosis during the first clinical visit (P<.001; OR 3.549, 95% CI 2.827?4.455), the time interval from onset to treatment (P<.001; OR 1.043, 95% CI 1.022?1.063), and a delay of more than 3 days from the first treatment to diagnosis (P<.001; OR 2.403, 95% CI 1.823?3.164). Additionally, the risk factors pertaining to P ovale involve misdiagnosis at the initial clinical visit (P=.01; OR 2.901, 95% CI 1.336?6.298), the time interval from onset to treatment (P=.002; OR 1.095, 95% CI 1.033?1.160), and the duration from the initial treatment to diagnosis (P=.43; OR 1.032, 95% CI 0.953?1.118). Previous infections can prevent the progression of both P falciparum and P ovale. Conclusions: This study showed that the increasing proportion of P ovale in recent years should not be ignored. Furthermore, there is a need to improve diagnostic awareness, enhance the capacity of medical institutions, and provide health education for high-risk groups. UR - https://publichealth.jmir.org/2024/1/e52089 UR - http://dx.doi.org/10.2196/52089 ID - info:doi/10.2196/52089 ER - TY - JOUR AU - Lundberg, L. Alexander AU - Ozer, A. Egon AU - Wu, A. Scott AU - Soetikno, G. Alan AU - Welch, B. Sarah AU - Liu, Yingxuan AU - Havey, J. Robert AU - Murphy, L. Robert AU - Hawkins, Claudia AU - Mason, Maryann AU - Achenbach, J. Chad AU - Post, A. Lori PY - 2024/8/28 TI - Surveillance Metrics and History of the COVID-19 Pandemic in Central Asia: Updated Epidemiological Assessment JO - JMIR Public Health Surveill SP - e52318 VL - 10 KW - SARS-CoV-2 KW - COVID-19 KW - Central Asia KW - pandemic KW - surveillance KW - public health KW - COVID-19 transmission KW - speed KW - acceleration KW - deceleration KW - jerk KW - dynamic panel KW - generalized method of moments KW - GMM KW - Arellano-Bond KW - 7-day lag KW - Armenia KW - Azerbaijan KW - Cyprus KW - Faeroe Islands KW - Georgia KW - Gibraltar KW - Kazakhstan KW - Kosovo KW - Kyrgyzstan KW - Macedonia KW - Russia KW - Tajikistan Turkey KW - Turkmenistan KW - Uzbekistan N2 - Background: This study updates the COVID-19 pandemic surveillance in Central Asia we conducted during the first year of the pandemic by providing 2 additional years of data for the region. The historical context provided through additional data can inform regional preparedness and early responses to infectious outbreaks of either the SARS-CoV-2 virus or future pathogens in Central Asia. Objective: First, we aim to measure whether there was an expansion or contraction in the pandemic in Central Asia when the World Health Organization (WHO) declared the end of the public health emergency for the COVID-19 pandemic on May 5, 2023. Second, we use dynamic and genomic surveillance methods to describe the history of the pandemic in the region and situate the window of the WHO declaration within the broader history. Third, we aim to provide historical context for the course of the pandemic in Central Asia. Methods: Traditional surveillance metrics, including counts and rates of COVID-19 transmissions and deaths, and enhanced surveillance indicators, including speed, acceleration, jerk, and persistence, were used to measure shifts in the pandemic. To identify the appearance and duration of variants of concern, we used data on sequenced SARS-CoV-2 variants from the Global Initiative on Sharing All Influenza Data (GISAID). We used Nextclade nomenclature to collect clade designations from sequences and Pangolin nomenclature for lineage designations of SARS-CoV-2. Finally, we conducted a 1-sided t test to determine whether regional speed was greater than an outbreak threshold of 10. We ran the test iteratively with 6 months of data across the sample period. Results: Speed for the region had remained below the outbreak threshold for 7 months by the time of the WHO declaration. Acceleration and jerk were also low and stable. Although the 1- and 7-day persistence coefficients remained statistically significant, the coefficients were relatively small in magnitude (0.125 and 0.347, respectively). Furthermore, the shift parameters for either of the 2 most recent weeks around May 5, 2023, were both significant and negative, meaning the clustering effect of new COVID-19 cases became even smaller in the 2 weeks around the WHO declaration. From December 2021 onward, Omicron was the predominant variant of concern in sequenced viral samples. The rolling t test of speed equal to 10 became entirely insignificant for the first time in March 2023. Conclusions: Although COVID-19 continues to circulate in Central Asia, the rate of transmission remained well below the threshold of an outbreak for 7 months ahead of the WHO declaration. COVID-19 appeared to be endemic in the region and no longer reached the threshold of a pandemic. Both standard and enhanced surveillance metrics suggest the pandemic had ended by the time of the WHO declaration. UR - https://publichealth.jmir.org/2024/1/e52318 UR - http://dx.doi.org/10.2196/52318 UR - http://www.ncbi.nlm.nih.gov/pubmed/39013115 ID - info:doi/10.2196/52318 ER - TY - JOUR AU - Kim, Ae Seung AU - Han, Kyungdo AU - Choi, Soyoun AU - Youn, Sojung Michelle AU - Jang, Hyemin AU - Lee, Ji Mi PY - 2024/8/23 TI - Effect of Smoking on the Development of Migraine in Women: Nationwide Cohort Study in South Korea JO - JMIR Public Health Surveill SP - e58105 VL - 10 KW - smoking KW - migraine KW - premenopausal women KW - postmenopausal women KW - incidence KW - risk N2 - Background: Smoking is known to be a significant risk factor for various diseases. Migraine, a condition requiring careful lifestyle management, currently lacks specific guidelines advocating for smoking cessation as a preventive measure. Although cross-sectional studies have suggested a potential link between smoking and an increased risk of migraine, the findings have been inconsistent and conflicting. To date, there has been no longitudinal study which investigated the effect of smoking on the risk of migraine in a prospective setting. Objective: This longitudinal study aimed to investigate the impact of smoking on the incidence of migraine in women and examine the modifying effect of menopausal status. Methods: Using nationally representative National Health Insurance Service (NHIS) data, women aged ?40 years who participated in national breast cancer screening in 2009 were followed-up until the end of 2019. Baseline data on smoking status (non-, ex-, and current smoker) as well as the duration and amount of cigarette smoking were collected. A Cox proportional hazards regression model was used to examine the independent effect of smoking on the risk of incident migraine after adjusting for demographics, comorbidities, and female reproductive factors. The results were stratified by menopausal status, and an interaction analysis (smoking × menopause) was performed. Results: In total, 1,827,129 women were included in the analysis. Women with a history of smoking exhibited a higher risk of developing migraine, compared with nonsmokers. Specifically, a higher risk of migraine was observed in women with past (adjusted hazard ratio [HR] 1.044, 95% CI 1.000-1.089) and current cigarette use (adjusted HR 1.050, 95% CI, 1.023-1.079) than in nonsmokers. The effect was greater in premenopausal women (adjusted HR 1.140, 95% CI, 1.108-1.172) than in postmenopausal women (adjusted HR 1.045, 95% CI 1.018-1.073; P<.001). The risk increased with an increased amount of smoking, with a greater association in premenopausal women (P<.001). Conclusions: Smoking increases the risk of migraine in women, with a dose-dependent relationship. Menopause modifies this effect. Our findings suggest that smoking is an important modifiable risk factor of migraine, with a higher impact in premenopausal women. The interaction between smoking and estrogen may increase the vulnerability of the migraine brain. UR - https://publichealth.jmir.org/2024/1/e58105 UR - http://dx.doi.org/10.2196/58105 ID - info:doi/10.2196/58105 ER - TY - JOUR AU - Chang, Min-Chien AU - Wen, Tzai-Hung PY - 2024/8/20 TI - The Mediating Role of Human Mobility in Temporal-Lagged Relationships Between Risk Perception and COVID-19 Dynamics in Taiwan: Statistical Modeling for Comparing the Pre-Omicron and Omicron Eras JO - JMIR Public Health Surveill SP - e55183 VL - 10 KW - human mobility KW - risk perception KW - COVID-19 KW - Omicron KW - Taiwan KW - pandemic KW - disease transmission KW - pandemic dynamics KW - global threats KW - infectious disease KW - behavioural health KW - public health KW - surveillance N2 - Background: The COVID-19 pandemic has profoundly impacted all aspects of human life for over 3 years. Understanding the evolution of public risk perception during these periods is crucial. Few studies explore the mechanisms for reducing disease transmission due to risk perception. Thus, we hypothesize that changes in human mobility play a mediating role between risk perception and the progression of the pandemic. Objective: The study aims to explore how various forms of human mobility, including essential, nonessential, and job-related behaviors, mediate the temporal relationships between risk perception and pandemic dynamics. Methods: We used distributed-lag linear structural equation models to compare the mediating impact of human mobility across different virus variant periods. These models examined the temporal dynamics and time-lagged effects among risk perception, changes in mobility, and virus transmission in Taiwan, focusing on two distinct periods: (1) April-August 2021 (pre-Omicron era) and (2) February-September 2022 (Omicron era). Results: In the pre-Omicron era, our findings showed that an increase in public risk perception correlated with significant reductions in COVID-19 cases across various types of mobility within specific time frames. Specifically, we observed a decrease of 5.59 (95% CI ?4.35 to ?6.83) COVID-19 cases per million individuals after 7 weeks in nonessential mobility, while essential mobility demonstrated a reduction of 10.73 (95% CI ?9.6030 to ?11.8615) cases after 8 weeks. Additionally, job-related mobility resulted in a decrease of 3.96 (95% CI ?3.5039 to ?4.4254) cases after 11 weeks. However, during the Omicron era, these effects notably diminished. A reduction of 0.85 (95% CI ?1.0046 to ?0.6953) cases through nonessential mobility after 10 weeks and a decrease of 0.69 (95% CI ?0.7827 to ?0.6054) cases through essential mobility after 12 weeks were observed. Conclusions: This study confirms that changes in mobility serve as a mediating factor between heightened risk perception and pandemic mitigation in both pre-Omicron and Omicron periods. This suggests that elevating risk perception is notably effective in impeding virus progression, especially when vaccines are unavailable or their coverage remains limited. Our findings provide significant value for health authorities in devising policies to address the global threats posed by emerging infectious diseases. UR - https://publichealth.jmir.org/2024/1/e55183 UR - http://dx.doi.org/10.2196/55183 ID - info:doi/10.2196/55183 ER - TY - JOUR AU - Pham, Hai-Thanh AU - Do, Toan AU - Baek, Jonggyu AU - Nguyen, Cong-Khanh AU - Pham, Quang-Thai AU - Nguyen, L. Hoa AU - Goldberg, Robert AU - Pham, Loc Quang AU - Giang, Minh Le PY - 2024/8/20 TI - Handling Missing Data in COVID-19 Incidence Estimation: Secondary Data Analysis JO - JMIR Public Health Surveill SP - e53719 VL - 10 KW - imputation method KW - COVID-19 incidence rate KW - crude bias KW - crude RMSE KW - root mean square error KW - percentage change KW - pandemic KW - Vietnam KW - surveillance KW - population health KW - analytical method N2 - Background: The COVID-19 pandemic has revealed significant challenges in disease forecasting and in developing a public health response, emphasizing the need to manage missing data from various sources in making accurate forecasts. Objective: We aimed to show how handling missing data can affect estimates of the COVID-19 incidence rate (CIR) in different pandemic situations. Methods: This study used data from the COVID-19/SARS-CoV-2 surveillance system at the National Institute of Hygiene and Epidemiology, Vietnam. We separated the available data set into 3 distinct periods: zero COVID-19, transition, and new normal. We randomly removed 5% to 30% of data that were missing completely at random, with a break of 5% at each time point in the variable daily caseload of COVID-19. We selected 7 analytical methods to assess the effects of handling missing data and calculated statistical and epidemiological indices to measure the effectiveness of each method. Results: Our study examined missing data imputation performance across 3 study time periods: zero COVID-19 (n=3149), transition (n=1290), and new normal (n=9288). Imputation analyses showed that K-nearest neighbor (KNN) had the lowest mean absolute percentage change (APC) in CIR across the range (5% to 30%) of missing data. For instance, with 15% missing data, KNN resulted in 10.6%, 10.6%, and 9.7% average bias across the zero COVID-19, transition, and new normal periods, compared to 39.9%, 51.9%, and 289.7% with the maximum likelihood method. The autoregressive integrated moving average model showed the greatest mean APC in the mean number of confirmed cases of COVID-19 during each COVID-19 containment cycle (CCC) when we imputed the missing data in the zero COVID-19 period, rising from 226.3% at the 5% missing level to 6955.7% at the 30% missing level. Imputing missing data with median imputation methods had the lowest bias in the average number of confirmed cases in each CCC at all levels of missing data. In detail, in the 20% missing scenario, while median imputation had an average bias of 16.3% for confirmed cases in each CCC, which was lower than the KNN figure, maximum likelihood imputation showed a bias on average of 92.4% for confirmed cases in each CCC, which was the highest figure. During the new normal period in the 25% and 30% missing data scenarios, KNN imputation had average biases for CIR and confirmed cases in each CCC ranging from 21% to 32% for both, while maximum likelihood and moving average imputation showed biases on average above 250% for both CIR and confirmed cases in each CCC. Conclusions: Our study emphasizes the importance of understanding that the specific imputation method used by investigators should be tailored to the specific epidemiological context and data collection environment to ensure reliable estimates of the CIR. UR - https://publichealth.jmir.org/2024/1/e53719 UR - http://dx.doi.org/10.2196/53719 ID - info:doi/10.2196/53719 ER - TY - JOUR AU - Riggins, P. Daniel AU - Zhang, Huiyuan AU - Trick, E. William PY - 2024/8/20 TI - Using Social Vulnerability Indices to Predict Priority Areas for Prevention of Sudden Unexpected Infant Death in Cook County, IL: Cross-Sectional Study JO - JMIR Public Health Surveill SP - e48825 VL - 10 KW - infant KW - socioeconomic disparities in health KW - sudden unexpected infant death KW - SUID KW - sudden infant death KW - SID KW - geographic information systems KW - structural racism KW - predict KW - social vulnerability KW - racial disparity KW - socioeconomic KW - disparity KW - child KW - infancy KW - pediatric KW - sudden infant death syndrome KW - SIDS N2 - Background: The incidence of sudden unexpected infant death (SUID) in the United States has persisted at roughly the same level since the mid-2000s, despite intensive prevention efforts around safe sleep. Disparities in outcomes across racial and socioeconomic lines also persist. These disparities are reflected in the spatial distribution of cases across neighborhoods. Strategies for prevention should be targeted precisely in space and time to further reduce SUID and correct disparities. Objective: We sought to aid neighborhood-level prevention efforts by characterizing communities where SUID occurred in Cook County, IL, from 2015 to 2019 and predicting where it would occur in 2021?2025 using a semiautomated, reproducible workflow based on open-source software and data. Methods: This cross-sectional retrospective study queried geocoded medical examiner data from 2015?2019 to identify SUID cases in Cook County, IL, and aggregated them to ?communities? as the unit of analysis. We compared demographic factors in communities affected by SUID versus those unaffected using Wilcoxon rank sum statistical testing. We used social vulnerability indicators from 2014 to train a negative binomial prediction model for SUID case counts in each given community for 2015?2019. We applied indicators from 2020 to the trained model to make predictions for 2021?2025. Results: Validation of our query of medical examiner data produced 325 finalized cases with a sensitivity of 95% (95% CI 93%?97%) and a specificity of 98% (95% CI 94%?100%). Case counts at the community level ranged from a minimum of 0 to a maximum of 17. A map of SUID case counts showed clusters of communities in the south and west regions of the county. All communities with the highest case counts were located within Chicago city limits. Communities affected by SUID exhibited lower median proportions of non-Hispanic White residents at 17% versus 60% (P<.001) and higher median proportions of non-Hispanic Black residents at 32% versus 3% (P<.001). Our predictive model showed moderate accuracy when assessed on the training data (Nagelkerke R2=70.2% and RMSE=17.49). It predicted Austin (17 cases), Englewood (14 cases), Auburn Gresham (12 cases), Chicago Lawn (12 cases), and South Shore (11 cases) would have the largest case counts between 2021 and 2025. Conclusions: Sharp racial and socioeconomic disparities in SUID incidence persisted within Cook County from 2015 to 2019. Our predictive model and maps identify precise regions within the county for local health departments to target for intervention. Other jurisdictions can adapt our coding workflows and data sources to predict which of their own communities will be most affected by SUID. UR - https://publichealth.jmir.org/2024/1/e48825 UR - http://dx.doi.org/10.2196/48825 ID - info:doi/10.2196/48825 ER - TY - JOUR AU - Wang, Haitao AU - Geng, Mengjie AU - Schikowski, Tamara AU - Areal, Tracey Ashtyn AU - Hu, Kejia AU - Li, Wen AU - Coelho, Stagliorio Micheline de Sousa Zanotti AU - Saldiva, Nascimento Paulo Hilário AU - Sun, Wei AU - Zhou, Chengchao AU - Lu, Liang AU - Zhao, Qi AU - Ma, Wei PY - 2024/8/13 TI - Increased Risk of Influenza Infection During Cold Spells in China: National Time Series Study JO - JMIR Public Health Surveill SP - e55822 VL - 10 KW - influenza KW - cold spell KW - definition KW - vulnerable population KW - modification effect KW - China N2 - Background: Studies have reported the adverse effects of cold events on influenza. However, the role of critical factors, such as characteristics of cold spells, and regional variations remain unresolved. Objective: We aimed to systematically evaluate the association between cold spells and influenza incidence in mainland China. Methods: This time series analysis used surveillance data of daily influenza from 325 sites in China in the 2014?2019 period. A total of 15 definitions of cold spells were adopted based on combinations of temperature thresholds and days of duration. A distributed lag linear model was used to estimate the short-term effects of cold spells on influenza incidence during the cool seasons (November to March), and we further explored the potential impact of cold spell characteristics (ie, intensity, duration, and timing during the season) on the estimated associations. Meta-regressions were used to evaluate the modification effect of city-level socioeconomic indicators. Results: The overall effect of cold spells on influenza incidence increased with the temperature threshold used to define cold spells, whereas the added effects were generally small and not statistically significant. The relative risk of influenza-associated with cold spells was 3.35 (95% CI 2.89?3.88), and the estimated effects were stronger during the middle period of cool seasons. The health effects of cold spells varied geographically and residents in Jiangnan region were vulnerable groups (relative risk 7.36, 95% CI 5.44?9.95). The overall effects of cold spells were positively correlated with the urban population density, population size, gross domestic product per capita, and urbanization rate, indicating a sterner response to cold spells in metropolises. Conclusions: Cold spells create a substantial health burden on seasonal influenza in China. Findings on regional and socioeconomic differences in the health effects of cold spells on seasonal influenza may be useful in formulating region-specific public health policies to address the hazardous effects of cold spells. UR - https://publichealth.jmir.org/2024/1/e55822 UR - http://dx.doi.org/10.2196/55822 ID - info:doi/10.2196/55822 ER - TY - JOUR AU - Xu, Ting AU - Ni, Haobo AU - Cai, Xiaoyan AU - Dai, Tingting AU - Wang, Lingxi AU - Xiao, Lina AU - Zeng, Qinghui AU - Yu, Xiaolin AU - Han, Lu AU - Guo, Pi PY - 2024/8/2 TI - Association Between Particulate Matter Exposure and Preterm Birth in Women With Abnormal Preconception Thyrotropin Levels: Large Cohort Study JO - JMIR Public Health Surveill SP - e53879 VL - 10 KW - PM2.5 KW - particulate matter with an aerodynamic diameter of ?2.5 ?m KW - thyroid stimulating hormone KW - preterm birth KW - cohort study KW - preconception N2 - Background: Prior research has linked exposure to particulate matter with an aerodynamic diameter of ?2.5 ?m (PM2.5) with preterm birth (PTB). However, the modulating effect of preconception thyroid stimulating hormone (TSH) levels on the relationship between PM2.5 exposure and PTB has not been investigated. Objective: This study aimed to assess whether preconception TSH levels modulate the impact of PM2.5 exposure on PTB. Methods: This cohort study was conducted in Guangdong, China, as a part of the National Free Pre-Pregnancy Checkups Project. PM2.5 exposure was estimated by using the inverse distance weighting method. To investigate the moderating effects of TSH levels on trimester-specific PM2.5 exposure and PTB, we used the Cox proportional hazards model. Additionally, to identify the susceptible exposure windows for weekly specific PM2.5 exposure and PTB, we built distributed lag models incorporating Cox proportional hazards models. Results: A total of 633,516 women who delivered between January 1, 2014, to December 31, 2019, were included. In total, 34,081 (5.4%) of them had abnormal preconception TSH levels. During the entire pregnancy, each 10-?g/m3 increase in PM2.5 was linked to elevated risks of PTB (hazard ratio [HR] 1.559, 95% CI 1.390?1.748), early PTB (HR 1.559, 95% CI 1.227?1.980), and late PTB (HR 1.571, 95% CI 1.379?1.791) among women with abnormal TSH levels. For women with normal preconception TSH levels, PM2.5 exposure during the entire pregnancy was positively associated with the risk of PTB (HR 1.345, 95% CI 1.307?1.385), early PTB (HR 1.203, 95% CI 1.126?1.285), and late PTB (HR 1.386, 95% CI 1.342?1432). The critical susceptible exposure windows were the 3rd-13th and 28th-35th gestational weeks for women with abnormal preconception TSH levels, compared to the 1st-13th and 21st-35th gestational weeks for those with normal preconception TSH levels. Conclusions: PM2.5 exposure was linked with a higher PTB risk, particularly in women with abnormal preconception TSH levels. PM2.5 exposure appears to have a greater effect on pregnant women who are in the early or late stages of pregnancy. UR - https://publichealth.jmir.org/2024/1/e53879 UR - http://dx.doi.org/10.2196/53879 ID - info:doi/10.2196/53879 ER - TY - JOUR AU - Liu, Jiaojiao AU - Wang, Hui AU - Zhong, Siyi AU - Zhang, Xiao AU - Wu, Qilin AU - Luo, Haipeng AU - Luo, Lei AU - Zhang, Zhoubin PY - 2024/8/2 TI - Spatiotemporal Changes and Influencing Factors of Hand, Foot, and Mouth Disease in Guangzhou, China, From 2013 to 2022: Retrospective Analysis JO - JMIR Public Health Surveill SP - e58821 VL - 10 KW - hand, foot, and mouth disease KW - spatial analysis KW - space-time scan statistics KW - geographically and temporally weighted regression KW - infectious disease N2 - Background: In the past 10 years, the number of hand, foot, and mouth disease (HFMD) cases reported in Guangzhou, China, has averaged about 60,000 per year. It is necessary to conduct an in-depth analysis to understand the epidemiological pattern and related influencing factors of HFMD in this region. Objective: This study aims to describe the epidemiological characteristics and spatiotemporal distribution of HFMD cases in Guangzhou from 2013 to 2022 and explore the relationship between sociodemographic factors and HFMD incidence. Methods: The data of HFMD cases in Guangzhou come from the Infectious Disease Information Management System of the Guangzhou Center for Disease Control and Prevention. Spatial analysis and space-time scan statistics were used to visualize the spatiotemporal distribution of HFMD cases. Multifactor ordinary minimum regression model, geographically weighted regression, and geographically and temporally weighted regression were used to analyze the influencing factors, including population, economy, education, and medical care. Results: From 2013 to 2022, a total of 599,353 HFMD cases were reported in Guangzhou, with an average annual incidence rate of 403.62/100,000. Children aged 5 years and younger accounted for 93.64% (561,218/599,353) of all cases. HFMD cases showed obvious bimodal distribution characteristics, with the peak period from May to July and the secondary peak period from August to October. HFMDs in Guangzhou exhibited a spatial aggregation trend, with the central urban area showing a pattern of low-low aggregation and the peripheral urban area demonstrating high-high aggregation. High-risk areas showed a dynamic trend of shifting from the west to the east of peripheral urban areas, with coverage first increasing and then decreasing. The geographically and temporally weighted regression model results indicated that population density (?=?0.016) and average annual income of employees (?=?0.007) were protective factors for HFMD incidence, while the average number of students in each primary school (?=1.416) and kindergarten (?=0.412) was a risk factor. Conclusions: HFMD cases in Guangzhou were mainly infants and young children, and there were obvious differences in time and space. HFMD is highly prevalent in summer and autumn, and peripheral urban areas were identified as high-risk areas. Improving the economic level of peripheral urban areas and reducing the number of students in preschool education institutions are key strategies to controlling HFMD. UR - https://publichealth.jmir.org/2024/1/e58821 UR - http://dx.doi.org/10.2196/58821 ID - info:doi/10.2196/58821 ER - TY - JOUR AU - Tao, Mingyong AU - Liu, Ying AU - Ling, Feng AU - Ren, Jiangping AU - Zhang, Rong AU - Shi, Xuguang AU - Guo, Song AU - Jiang, Jianmin AU - Sun, Jimin PY - 2024/8/2 TI - Factors Associated With the Spatial Distribution of Severe Fever With Thrombocytopenia Syndrome in Zhejiang Province, China: Risk Analysis Based on Maximum Entropy JO - JMIR Public Health Surveill SP - e46070 VL - 10 KW - severe fever with thrombocytopenia syndrome KW - MaxEnt KW - maximum entropy KW - tick density KW - spatial distribution KW - risk factor KW - China N2 - Background: Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease that was first identified in mainland China in 2009 and has been reported in Zhejiang Province, China, since 2011. However, few studies have focused on the association between ticks, host animals, and SFTS. Objective: In this study, we analyzed the influence of meteorological and environmental factors as well as the influence of ticks and host animals on SFTS. This can serve as a foundational basis for the development of strategic policies aimed at the prevention and control of SFTS. Methods: Data on SFTS incidence, tick density, cattle density, and meteorological and environmental factors were collected and analyzed using a maximum entropy?based model. Results: As of December 2019, 463 laboratory-confirmed SFTS cases were reported in Zhejiang Province. We found that the density of ticks, precipitation in the wettest month, average temperature, elevation, and the normalized difference vegetation index were significantly associated with SFTS spatial distribution. The niche model fitted accurately with good performance in predicting the potential risk areas of SFTS (the average test area under the receiver operating characteristic curve for the replicate runs was 0.803 and the SD was 0.013). The risk of SFTS occurrence increased with an increase in tick density, and the response curve indicated that the risk was greater than 0.5 when tick density exceeded 1.4. The risk of SFTS occurrence decreased with increased precipitation in the wettest month, and the risk was less than 0.5 when precipitation exceeded 224.4 mm. The relationship between elevation and SFTS occurrence showed a reverse V shape, and the risk peaked at approximately 400 m. Conclusions: Tick density, precipitation, and elevation were dominant influencing factors for SFTS, and comprehensive intervention measures should be adjusted according to these factors to reduce SFTS incidence in Zhejiang Province. UR - https://publichealth.jmir.org/2024/1/e46070 UR - http://dx.doi.org/10.2196/46070 ID - info:doi/10.2196/46070 ER - TY - JOUR AU - Chen, Yu AU - Chen, Shouhang AU - Shen, Yuanfang AU - Li, Zhi AU - Li, Xiaolong AU - Zhang, Yaodong AU - Zhang, Xiaolong AU - Wang, Fang AU - Jin, Yuefei PY - 2024/7/31 TI - Molecular Evolutionary Dynamics of Coxsackievirus A6 Causing Hand, Foot, and Mouth Disease From 2021 to 2023 in China: Genomic Epidemiology Study JO - JMIR Public Health Surveill SP - e59604 VL - 10 KW - coxsackievirus A6 KW - hand, foot, and mouth disease KW - evolution KW - molecular epidemiology KW - China KW - CV-A6 KW - HFMD N2 - Background: Hand, foot, and mouth disease (HFMD) is a global public health concern, notably within the Asia-Pacific region. Recently, the primary pathogen causing HFMD outbreaks across numerous countries, including China, is coxsackievirus (CV) A6, one of the most prevalent enteroviruses in the world. It is a new variant that has undergone genetic recombination and evolution, which might not only induce modifications in the clinical manifestations of HFMD but also heighten its pathogenicity because of nucleotide mutation accumulation. Objective: The study assessed the epidemiological characteristics of HFMD in China and characterized the molecular epidemiology of the major pathogen (CV-A6) causing HFMD. We attempted to establish the association between disease progression and viral genetic evolution through a molecular epidemiological study. Methods: Surveillance data from the Chinese Center for Disease Control and Prevention from 2021 to 2023 were used to analyze the epidemiological seasons and peaks of HFMD in Henan, China, and capture the results of HFMD pathogen typing. We analyzed the evolutionary characteristics of all full-length CV-A6 sequences in the NCBI database and the isolated sequences in Henan. To characterize the molecular evolution of CV-A6, time-scaled tree and historical population dynamics regarding CV-A6 sequences were estimated. Additionally, we analyzed the isolated strains for mutated or missing amino acid sites compared to the prototype CV-A6 strain. Results: The 2021-2023 epidemic seasons for HFMD in Henan usually lasted from June to August, with peaks around June and July. The monthly case reporting rate during the peak period ranged from 20.7% (4854/23,440) to 35% (12,135/34,706) of the total annual number of cases. Analysis of the pathogen composition of 2850 laboratory-confirmed cases identified 8 enterovirus serotypes, among which CV-A6 accounted for the highest proportion (652/2850, 22.88%). CV-A6 emerged as the major pathogen for HFMD in 2022 (203/732, 27.73%) and 2023 (262/708, 37.01%). We analyzed all CV-A6 full-length sequences in the NCBI database and the evolutionary features of viruses isolated in Henan. In China, the D3 subtype gradually appeared from 2011, and by 2019, all CV-A6 virus strains belonged to the D3 subtype. The VP1 sequences analyzed in Henan showed that its subtypes were consistent with the national subtypes. Furthermore, we analyzed the molecular evolutionary features of CV-A6 using Bayesian phylogeny and found that the most recent common ancestor of CV-A6 D3 dates back to 2006 in China, earlier than the 2011 HFMD outbreak. Moreover, the strains isolated in 2023 had mutations at several amino acid sites compared to the original strain. Conclusions: The CV-A6 virus may have been introduced and circulating covertly within China prior to the large-scale HFMD outbreak. Our laboratory testing data confirmed the fluctuation and periodic patterns of CV-A6 prevalence. Our study provides valuable insights into understanding the evolutionary dynamics of CV-A6. UR - https://publichealth.jmir.org/2024/1/e59604 UR - http://dx.doi.org/10.2196/59604 ID - info:doi/10.2196/59604 ER - TY - JOUR AU - Chen, Yang AU - Zhou, Lidan AU - Zha, Yuanyi AU - Wang, Yujin AU - Wang, Kai AU - Lu, Lvliang AU - Guo, Pi AU - Zhang, Qingying PY - 2024/7/23 TI - 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 JO - JMIR Public Health Surveill SP - e51883 VL - 10 KW - mortality burden KW - nonaccidental deaths KW - multivariate meta-analysis KW - distributed lagged nonlinear mode KW - attributable risk KW - climate change KW - human health KW - association KW - temperature KW - mortality KW - nonaccidental death KW - spatial heterogeneity KW - meteorological data KW - temperature esposure KW - heterogeneous KW - spatial planning KW - environmental temperature KW - prefecture-level KW - resource allocation N2 - 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. UR - https://publichealth.jmir.org/2024/1/e51883 UR - http://dx.doi.org/10.2196/51883 ID - info:doi/10.2196/51883 ER - TY - JOUR AU - Lee, JinWook AU - Park, JuWon AU - Kim, Nayeon AU - Nari, Fatima AU - Bae, Seowoo AU - Lee, Ji Hyeon AU - Lee, Mingyu AU - Jun, Kwan Jae AU - Choi, Son Kui AU - Suh, Mina PY - 2024/7/22 TI - Socioeconomic Disparities in Six Common Cancer Survival Rates in South Korea: Population-Wide Retrospective Cohort Study JO - JMIR Public Health Surveill SP - e55011 VL - 10 KW - cancer survival KW - income level KW - socioeconomic status KW - deprivation index KW - inequality KW - nationwide analysis KW - cancer KW - South Korea KW - public health N2 - Background: In South Korea, the cancer incidence rate has increased by 56.5% from 2001 to 2021. Nevertheless, the 5-year cancer survival rate from 2017 to 2021 increased by 17.9% compared with that from 2001 to 2005. Cancer survival rates tend to decline with lower socioeconomic status, and variations exist in the survival rates among different cancer types. Analyzing socioeconomic patterns in the survival of patients with cancer can help identify high-risk groups and ensure that they benefit from interventions. Objective: The aim of this study was to analyze differences in survival rates among patients diagnosed with six types of cancer?stomach, colorectal, liver, breast, cervical, and lung cancers?based on socioeconomic status using Korean nationwide data. Methods: This study used the Korea Central Cancer Registry database linked to the National Health Information Database to follow up with patients diagnosed with cancer between 2014 and 2018 until December 31, 2021. Kaplan-Meier curves stratified by income status were generated, and log-rank tests were conducted for each cancer type to assess statistical significance. Hazard ratios with 95% CIs for any cause of overall survival were calculated using Cox proportional hazards regression models with the time since diagnosis. Results: The survival rates for the six different types of cancer were as follows: stomach cancer, 69.6% (96,404/138,462); colorectal cancer, 66.6% (83,406/125,156); liver cancer, 33.7% (23,860/70,712); lung cancer, 30.4% (33,203/109,116); breast cancer, 91.5% (90,730/99,159); and cervical cancer, 78% (12,930/16,580). When comparing the medical aid group to the highest income group, the hazard ratios were 1.72 (95% CI 1.66?1.79) for stomach cancer, 1.60 (95% CI 1.54?1.56) for colorectal cancer, 1.51 (95% CI 1.45?1.56) for liver cancer, 1.56 (95% CI 1.51?1.59) for lung cancer, 2.19 (95% CI 2.01?2.38) for breast cancer, and 1.65 (95% CI 1.46?1.87) for cervical cancer. A higher deprivation index and advanced diagnostic stage were associated with an increased risk of mortality. Conclusions: Socioeconomic status significantly mediates disparities in cancer survival in several cancer types. This effect is particularly pronounced in less fatal cancers such as breast cancer. Therefore, considering the type of cancer and socioeconomic factors, social and medical interventions such as early cancer detection and appropriate treatment are necessary for vulnerable populations. UR - https://publichealth.jmir.org/2024/1/e55011 UR - http://dx.doi.org/10.2196/55011 ID - info:doi/10.2196/55011 ER - TY - JOUR AU - Valle, Jhaqueline AU - Lebensburger, D. Jeffrey AU - Garimella, S. Pranav AU - Gopal, Srila PY - 2024/7/15 TI - Prevalence, Mortality, and Access to Care for Chronic Kidney Disease in Medicaid-Enrolled Adults With Sickle Cell Disease in California: Retrospective Cohort Study JO - JMIR Public Health Surveill SP - e57290 VL - 10 KW - sickle cell disease KW - chronic kidney disease KW - prevalence KW - mortality KW - access to care KW - Medicaid KW - California KW - United States KW - retrospective KW - cohort study KW - investigate KW - emergency department KW - hospitalization KW - specialized care KW - adult KW - adults KW - hematologist KW - hematologists KW - nephrologist KW - nephrologists KW - t-test N2 - Background: Chronic kidney disease (CKD) is a significant complication in patients with sickle cell disease (SCD), leading to increased mortality. Objective: This study aims to investigate the burden of CKD in Medicaid-enrolled adults with SCD in California, examine differences in disease burden between male and female individuals, and assess mortality rates and access to specialized care. Methods: This retrospective cohort study used the California Sickle Cell Data Collection program to identify and monitor individuals with SCD. Medicaid claims, vital records, emergency department, and hospitalization data from 2011 to 2020 were analyzed. CKD prevalence was assessed based on ICD (International Classification of Diseases) codes, and mortality rates were calculated. Access to specialized care was examined through outpatient encounter rates with hematologists and nephrologists. Results: Among the 2345 adults with SCD, 24.4% (n=572) met the case definition for CKD. The SCD-CKD group was older at the beginning of this study (average age 44, SD 14 vs 34, SD 12.6 years) than the group without CKD. CKD prevalence increased with age, revealing significant disparities by sex. While the youngest (18-29 years) and oldest (>65 years) groups showed similar CKD prevalences between sexes (female: 12/111, 10.8% and male: 12/101, 11.9%; female: 74/147, 50.3% and male: 34/66, 51.5%, respectively), male individuals in the aged 30-59 years bracket exhibited significantly higher rates than female individuals (30-39 years: 49/294, 16.7%, P=.01; 40-49 years: 52/182, 28.6%, P=.02; and 50-59 years: 76/157,48.4%, P<.001). During this study, of the 2345 adults, 435 (18.5%) deaths occurred, predominantly within the SCD-CKD cohort (226/435, 39.5%). The median age at death was 53 (IQR 61-44) years for the SCD-CKD group compared to 43 (IQR 33-56) years for the SCD group, with male individuals in the SCD-CKD group showing significantly higher mortality rates (111/242, 45.9%; P=.009) than female individuals (115/330, 34.9%). Access to specialist care was notably limited: approximately half (281/572, 49.1%) of the SCD-CKD cohort had no hematologist visits, and 61.9% (354/572) did not see a nephrologist during this study?s period. Conclusions: This study provides robust estimates of CKD prevalence and mortality among Medicaid-enrolled adults with SCD in California. The findings highlight the need for improved access to specialized care for this population and increased awareness of the high mortality risk and progression associated with CKD. UR - https://publichealth.jmir.org/2024/1/e57290 UR - http://dx.doi.org/10.2196/57290 UR - http://www.ncbi.nlm.nih.gov/pubmed/39008353 ID - info:doi/10.2196/57290 ER - TY - JOUR AU - Zhang, Zhuo AU - Xue, Dongmei AU - Bian, Ying PY - 2024/7/12 TI - Association Between Socioeconomic Inequalities in Pain and All-Cause Mortality in the China Health and Retirement Longitudinal Study: Longitudinal Cohort Study JO - JMIR Public Health Surveill SP - e54309 VL - 10 KW - pain KW - equality KW - all-cause mortality KW - concentration index KW - decomposition N2 - Background: Few studies focus on the equality of pain, and the relationship between pain and death is inconclusive. Investigating the distribution of pain and potential mortality risks is crucial for ameliorating painful conditions and devising targeted intervention measures. Objective: Our study aimed to investigate the association between inequalities in pain and all-cause mortality in China. Methods: Longitudinal cohort data from waves 1 and 2 of the China Health and Retirement Longitudinal Study (2011-2013) were used in this study. Pain was self-reported at baseline, and death information was obtained from the 2013 follow-up survey. The concentration index and its decomposition were used to explain the inequality of pain, and the association between pain and death was analyzed with a Cox proportional risk model. Results: A total of 16,747 participants were included, with an average age of 59.57 (SD 9.82) years. The prevalence of pain was 32.54% (8196/16,747). Among participants with pain, the main pain type was moderate pain (1973/5426, 36.36%), and the common pain locations were the waist (3232/16,747, 19.3%), legs (2476/16,747, 14.78%) and head (2250/16,747, 13.44%). We found that the prevalence of pain was concentrated in participants with low economic status (concentration index ?0.066, 95% CI ?0.078 to ?0.054). Educational level (36.49%), location (36.87%), and economic status (25.05%) contributed significantly to the inequality of pain. In addition, Cox regression showed that pain was associated with an increased risk of all-cause mortality (hazard ratio 1.30, 95% CI 1.06-1.61). Conclusions: The prevalence of pain in Chinese adults is concentrated among participants with low economic status, and pain increases the risk of all-cause death. Our results highlight the importance of socioeconomic factors in reducing deaths due to pain inequalities by implementing targeted interventions. UR - https://publichealth.jmir.org/2024/1/e54309 UR - http://dx.doi.org/10.2196/54309 UR - http://www.ncbi.nlm.nih.gov/pubmed/38872381 ID - info:doi/10.2196/54309 ER - TY - JOUR AU - Mendlovic, Joseph AU - Mimouni, B. Francis PY - 2024/7/9 TI - Census-Dependent Mortality of Ventilated Patients With COVID-19 in Israel: Noninterventional Observational Cohort Study JO - Interact J Med Res SP - e41749 VL - 13 KW - COVID-19 KW - mortality KW - ventilation KW - intensive care KW - pandemic KW - contagious KW - disease KW - database KW - data KW - patient KW - medical KW - resources KW - validation KW - public policy KW - policy KW - health policy KW - global health policy N2 - Background: The COVID-19 pandemic led to several surges in the mass hospitalization rate. Extreme increases in hospital admissions without adequate medical resources may increase mortality. No study has addressed the impact of daily census of ventilated patients on mortality in the context of the pandemic in a nationwide setting. Objective: This study aimed to determine whether daily census of ventilated patients affected COVID-19 mortality rates nationwide in Israel. Methods: We conducted a cohort study using nationwide, public-domain, population-based COVID-19 data of hospitalized patients from an Israeli database from March 11, 2020, until February 11, 2021. We included all COVID-19 hospital admissions, classified as mild to severe per the Centers for Diseases Control and Prevention classification irrespective of whether they were mechanically ventilated. Outcome measures were daily death rates and death rates expressed as a percentage of ventilated patients. Results: During the study period (338 days from March 11, 2020, to February 11, 2021), 715,743 patients contracted and were clinically confirmed as having COVID-19. Among them, 5577 (0.78%) patients died. In total, 3398 patients were ventilated because of severe COVID-19. Daily mortality correlated with daily census of ventilated patients (R2=0.828, P<.001). The daily percent mortality of ventilated patients also correlated with the daily census of ventilated patients (R2=0.365, P<.001)?backward multiple regression analysis demonstrated that this positive correlation was still highly significant even when correcting for the average age or gender of ventilated patients (R2=0.4328, P<.001) or for the surge in their number. Overall, 40% of the variation in mortality was explained by variations in the daily census of ventilated patients. ANOVA revealed that at less than 50 ventilated patients per day, the daily mortality of ventilated patients was slightly above 5%, and it nearly doubled (10%) with 50-149 patients; moreover, in all categories of ?200 patients ventilated per day, it more than tripled at ?15% (P<.001). Conclusions: Daily mortality rates per ventilated patient increased with an increase in the number of ventilated patients, suggesting the saturation of medical resources. Policy makers should be aware that expanding medical services without adequate resources may increase mortality. Governments should perform similar analyses to provide indicators of system saturation, although further validation of these results might be needed to use this indicator to drive public policy. UR - https://www.i-jmr.org/2024/1/e41749 UR - http://dx.doi.org/10.2196/41749 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/41749 ER - TY - JOUR AU - Chen, Jiangyun AU - Wan, Jiahuan AU - Wu, Yibo AU - Gan, Li AU - Li, Haomiao AU - Zhou, Yan AU - Liu, Siyuan AU - Luo, Lan AU - Zhou, Haozheng AU - Yin, Xuanhao AU - Chang, Jinghui PY - 2024/7/5 TI - The Association Between Personality Traits and Health-Related Quality of Life and the Mediating Role of Smoking: Nationwide Cross-Sectional Study JO - JMIR Public Health Surveill SP - e51416 VL - 10 KW - Big Five personality KW - HRQOL KW - smoking KW - mediation KW - tobacco control KW - China KW - neuroticism KW - extraversion KW - agreeableness KW - health-related quality of life N2 - Background: There are positive and negative correlations in different directions between smoking, personality traits, and health-related quality of life (HRQOL), where smoking may mask the pathway between personality traits and HRQOL. Understanding the masking pathway of smoking between personality traits and HRQOL can elucidate the mechanisms of smoking?s psychosocial effects and provide new ideas for developing tobacco control strategies. Objective: The purpose of this study was to investigate the correlation between Big Five personality traits and HRQOL and whether smoking mediates the relationship between them. Methods: This was a cross-sectional study using data from 21,916 respondents from the 2022 Psychology and Behavior Investigation of Chinese Residents survey. Linear regression models were used to analyze the correlations between smoking, Big Five personality traits, and HRQOL while controlling for potential confounders. The mediating role of smoking on the association between Big Five Personality traits and HRQOL was analyzed using the Sobel-Goodman mediation test. Results: Extraversion (?=.001; P=.04), agreeableness (?=.003; P<.001), and neuroticism (?=.003; P<.001) were positively correlated with HRQOL, whereas openness was negatively correlated with HRQOL (?=?.001; P=.003). Smoking was associated with a decrease in HRQOL and mediated the positive effect of HRQOL on extraversion (z=?2.482; P=.004), agreeableness (z=?2.264; P=.02), and neuroticism (z=?3.230; P=.001). Subgroup analyses further showed that smoking mediated the effect of neuroticism on HRQOL in the population with chronic illnesses (z=?2.724; P=.006), and in the population without chronic illnesses, smoking contributed to the effect of HRQOL on extraversion (z=?2.299; P=.02), agreeableness (z=?2.382; P=.02), and neuroticism (z=?2.213; P=.03). Conclusions: This study provided evidence that there is a correlation between personality traits and HRQOL. It also found that smoking plays a role in mediating the connection between personality traits and HRQOL. The development of future tobacco control strategies should consider the unique traits of each individual?s personality, highlighting the significance of extraversion, agreeableness, and neuroticism. UR - https://publichealth.jmir.org/2024/1/e51416 UR - http://dx.doi.org/10.2196/51416 ID - info:doi/10.2196/51416 ER - TY - JOUR AU - Guo, Huagui AU - Zhang, Shuyu AU - Xie, Xinwei AU - Liu, Jiang AU - Ho, Chak Hung PY - 2024/7/3 TI - Moderation Effects of Streetscape Perceptions on the Associations Between Accessibility, Land Use Mix, and Bike-Sharing Use: Cross-Sectional Study JO - JMIR Public Health Surveill SP - e58761 VL - 10 KW - built environment KW - streetscape perceptions KW - bike-sharing use KW - cycling KW - moderation effect KW - China N2 - Background: Cycling is known to be beneficial for human health. Studies have suggested significant associations of physical activity with macroscale built environments and streetscapes. However, whether good streetscapes can amplify the benefits of a favorable built environment on physical activity remains unknown. Objective: This study examines whether streetscape perceptions can modify the associations between accessibility, land use mix, and bike-sharing use. Methods: This cross-sectional study used data from 18,019,266 bike-sharing orders during weekends in Shanghai, China. A 500 × 500 m grid was selected as the analysis unit to allocate data. Bike-sharing use was defined as the number of bike-sharing origins. Street view images and a human-machine adversarial scoring framework were combined to evaluate lively, safety, and wealthy perceptions. Negative binomial regression was developed to examine the independent effects of the three perceptual factors in both the univariate model and fully adjusted model, controlling for population density, average building height, distance to nearest transit, number of bus stations, number of points of interest, distance to the nearest park, and distance to the central business district. The moderation effect was then investigated through the interaction term between streetscape perception and accessibility and land use mix, based on the fully adjusted model. We also tested whether the findings of streetscape moderation effects are robust when examinations are performed at different geographic scales, using a small-sample statistics approach and different operationalizations of land use mix and accessibility. Results: High levels of lively, safety, and wealthy perceptions were correlated with more bike-sharing activities. There were negative effects for the interactions between the land use Herfindahl-Hirschman index with the lively perception (?=?0.63; P=.01) and safety perception (?=?0.52; P=.001). The interaction between the lively perception and road intersection density was positively associated with the number of bike-sharing uses (?=0.43; P=.08). Among these, the lively perception showed the greatest independent effect (?=1.29; P<.001), followed by the safety perception (?=1.22; P=.001) and wealthy perception (?=0.72; P=.001). The findings were robust in the three sensitivity analyses. Conclusions: A safer and livelier streetscape can enhance the benefits of land use mix in promoting bike-sharing use, with a safer streetscape also intensifying the effect of accessibility. Interventions focused on streetscape perceptions can encourage cycling behavior and enhance the benefits of accessibility and land use mix. This study also contributes to the literature on potential moderators of built environment healthy behavior associations from the perspective of microscale environmental perceptions. UR - https://publichealth.jmir.org/2024/1/e58761 UR - http://dx.doi.org/10.2196/58761 ID - info:doi/10.2196/58761 ER - TY - JOUR AU - Hanano, Maria AU - Rith-Najarian, Leslie AU - Gong-Guy, Elizabeth AU - Chavira, Denise PY - 2024/7/3 TI - Motivational Variables as Moderating Effects of a Web-Based Mental Health Program for University Students: Secondary Analysis of a Randomized Controlled Trial JO - JMIR Form Res SP - e56118 VL - 8 KW - web-based intervention KW - internal motivation KW - depression KW - anxiety KW - self-determination theory KW - mental health KW - university students KW - university KW - students KW - web-based KW - analysis KW - randomized controlled trial KW - self-guided N2 - Background: Self-guided web-based interventions have the potential of addressing help-seeking barriers and symptoms common among university students, such as depression and anxiety. Unfortunately, self-guided interventions are also associated with less adherence, implicating motivation as a potential moderator for adherence and improvement for such interventions. Previous studies examining motivation as a moderator or predictor of improvement on web-based interventions have defined and measured motivation variably, producing conflicting results. Objective: This secondary analysis of data from a randomized controlled trial aimed to examine constructs of motivation as moderators of improvement for a self-guided 8-week web-based intervention in university students (N=1607). Methods: Tested moderators included internal motivation, external motivation, and confidence in treatment derived from the Treatment Motivation Questionnaire. The primary outcome was an improvement in depression and anxiety measured by the Depression Anxiety Stress Scale-21. Results: Piecewise linear mixed effects models showed that internal motivation significantly moderated symptom change for the intervention group (t1504=?2.94; P=.003) at average and high (+1 SD) motivation levels (t1507=?2.28; P=.02 and t1507=?4.05; P<.001, respectively). Significant results remained even after controlling for baseline severity. The results showed that confidence in treatment did not significantly moderate symptom change for the intervention group (t1504=1.44; P=.15). In this sample, only internal motivation was positively correlated with service initiation, intervention adherence, and intervention satisfaction. Conclusions: The combination of a web-based intervention and high or moderate internal motivation resulted in greater improvement in the total Depression Anxiety Stress Scale-21 score. These findings highlight the importance of conceptually differentiating motivation-related constructs when examining moderators of improvement. The results suggest that the combination of a web-based intervention and high or moderate internal motivation results in greater improvement. These findings highlight the importance of conceptually differentiating motivation-related constructs when examining moderators of improvement. To better understand the moderating role of internal motivation, future research is encouraged to replicate these findings in diverse samples as well as to examine related constructs such as baseline severity and adherence. Understanding these characteristics informs treatment strategies to maximize adherence and improvement when developing web-based interventions as well as allows services to be targeted to individuals likely to benefit from such interventions. Trial Registration: ClinicalTrials.gov NCT04361045; https://clinicaltrials.gov/study/NCT04361045 UR - https://formative.jmir.org/2024/1/e56118 UR - http://dx.doi.org/10.2196/56118 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56118 ER - TY - JOUR AU - Lee, HyunHae AU - Kim, Ji-Su AU - Shin, Hyerine PY - 2024/6/28 TI - Predicting the Transition to Metabolically Unhealthy Obesity Among Young Adults With Metabolically Healthy Obesity in South Korea: Nationwide Population-Based Study JO - JMIR Public Health Surveill SP - e52103 VL - 10 KW - metabolically healthy obesity KW - metabolic syndrome KW - metabolically unhealthy obesity KW - nomogram KW - obesity KW - young adult KW - male KW - noncommunicable disease KW - South Korea KW - population-based study KW - intervention N2 - Background: Globally, over 39% of individuals are obese. Metabolic syndrome, usually accompanied by obesity, is regarded as a major contributor to noncommunicable diseases. Given this relationship, the concepts of metabolically healthy and unhealthy obesity, considering metabolic status, have been evolving. Attention is being directed to metabolically healthy people with obesity who have relatively low transition rates to noncommunicable diseases. As obesity rates continue to rise and unhealthy behaviors prevail among young adults, there is a growing need for obesity management that considers these metabolic statuses. A nomogram can be used as an effective tool to predict the risk of transitioning to metabolically unhealthy obesity from a metabolically healthy status. Objective: The study aimed to identify demographic factors, health behaviors, and 5 metabolic statuses related to the transition from metabolically healthy obesity to unhealthy obesity among people aged between 20 and 44 years and to develop a screening tool to predict this transition. Methods: This secondary analysis study used national health data from the National Health Insurance System in South Korea. We analyzed the customized data using SAS (SAS Institute Inc) and conducted logistic regression to identify factors related to the transition from metabolically healthy to unhealthy obesity. A nomogram was developed to predict the transition using the identified factors. Results: Among 3,351,989 people, there was a significant association between the transition from metabolically healthy to unhealthy obesity and general characteristics, health behaviors, and metabolic components. Male participants showed a 1.30 higher odds ratio for transitioning to metabolically unhealthy obesity than female participants, and people in the lowest economic status were also at risk for the transition (odds ratio 1.08, 95% CI 1.05-1.1). Smoking status, consuming >30 g of alcohol, and insufficient regular exercise were negatively associated with the transition. Each relevant variable was assigned a point value. When the nomogram total points reached 295, the shift from metabolically healthy to unhealthy obesity had a prediction rate of >50%. Conclusions: This study identified key factors for young adults transitioning from healthy to unhealthy obesity, creating a predictive nomogram. This nomogram, including triglycerides, waist circumference, high-density lipoprotein-cholesterol, blood pressure, and fasting glucose, allows easy assessment of obesity risk even for the general population. This tool simplifies predictions amid rising obesity rates and interventions. UR - https://publichealth.jmir.org/2024/1/e52103 UR - http://dx.doi.org/10.2196/52103 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52103 ER - TY - JOUR AU - Liu, Chuchu AU - Holme, Petter AU - Lehmann, Sune AU - Yang, Wenchuan AU - Lu, Xin PY - 2024/6/28 TI - Nonrepresentativeness of Human Mobility Data and its Impact on Modeling Dynamics of the COVID-19 Pandemic: Systematic Evaluation JO - JMIR Form Res SP - e55013 VL - 8 KW - human mobility KW - data representativeness KW - population composition KW - COVID-19 KW - epidemiological modeling N2 - Background: In recent years, a range of novel smartphone-derived data streams about human mobility have become available on a near?real-time basis. These data have been used, for example, to perform traffic forecasting and epidemic modeling. During the COVID-19 pandemic in particular, human travel behavior has been considered a key component of epidemiological modeling to provide more reliable estimates about the volumes of the pandemic?s importation and transmission routes, or to identify hot spots. However, nearly universally in the literature, the representativeness of these data, how they relate to the underlying real-world human mobility, has been overlooked. This disconnect between data and reality is especially relevant in the case of socially disadvantaged minorities. Objective: The objective of this study is to illustrate the nonrepresentativeness of data on human mobility and the impact of this nonrepresentativeness on modeling dynamics of the epidemic. This study systematically evaluates how real-world travel flows differ from census-based estimations, especially in the case of socially disadvantaged minorities, such as older adults and women, and further measures biases introduced by this difference in epidemiological studies. Methods: To understand the demographic composition of population movements, a nationwide mobility data set from 318 million mobile phone users in China from January 1 to February 29, 2020, was curated. Specifically, we quantified the disparity in the population composition between actual migrations and resident composition according to census data, and shows how this nonrepresentativeness impacts epidemiological modeling by constructing an age-structured SEIR (Susceptible-Exposed-Infected- Recovered) model of COVID-19 transmission. Results: We found a significant difference in the demographic composition between those who travel and the overall population. In the population flows, 59% (n=20,067,526) of travelers are young and 36% (n=12,210,565) of them are middle-aged (P<.001), which is completely different from the overall adult population composition of China (where 36% of individuals are young and 40% of them are middle-aged). This difference would introduce a striking bias in epidemiological studies: the estimation of maximum daily infections differs nearly 3 times, and the peak time has a large gap of 46 days. Conclusions: The difference between actual migrations and resident composition strongly impacts outcomes of epidemiological forecasts, which typically assume that flows represent underlying demographics. Our findings imply that it is necessary to measure and quantify the inherent biases related to nonrepresentativeness for accurate epidemiological surveillance and forecasting. UR - https://formative.jmir.org/2024/1/e55013 UR - http://dx.doi.org/10.2196/55013 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55013 ER - TY - JOUR AU - Wass, Minh Lily AU - O'Keeffe Hoare, Derek AU - Smits, Elena Georgia AU - Osman, Marwan AU - Zhang, Ning AU - Klepack, William AU - Parrilla, Lara AU - Busche, M. Jefferson AU - Clarkberg, E. Marin AU - Basu, Sumanta AU - Cazer, L. Casey PY - 2024/6/27 TI - Syndromic Surveillance Tracks COVID-19 Cases in University and County Settings: Retrospective Observational Study JO - JMIR Public Health Surveill SP - e54551 VL - 10 KW - COVID-19 KW - epidemiology KW - epidemiological KW - SARS-CoV-2 KW - syndromic surveillance KW - surveillance system KW - syndromic KW - surveillance KW - coronavirus KW - pandemic KW - epidemic KW - respiratory KW - infectious KW - predict KW - predictive KW - prediction KW - predictions N2 - Background: Syndromic surveillance represents a potentially inexpensive supplement to test-based COVID-19 surveillance. By strengthening surveillance of COVID-19?like illness (CLI), targeted and rapid interventions can be facilitated that prevent COVID-19 outbreaks without primary reliance on testing. Objective: This study aims to assess the temporal relationship between confirmed SARS-CoV-2 infections and self-reported and health care provider?reported CLI in university and county settings, respectively. Methods: We collected aggregated COVID-19 testing and symptom reporting surveillance data from Cornell University (2020?2021) and Tompkins County Health Department (2020?2022). We used negative binomial and linear regression models to correlate confirmed COVID-19 case counts and positive test rates with CLI rate time series, lagged COVID-19 cases or rates, and day of the week as independent variables. Optimal lag periods were identified using Granger causality and likelihood ratio tests. Results: In modeling undergraduate student cases, the CLI rate (P=.003) and rate of exposure to CLI (P<.001) were significantly correlated with the COVID-19 test positivity rate with no lag in the linear models. At the county level, the health care provider?reported CLI rate was significantly correlated with SARS-CoV-2 test positivity with a 3-day lag in both the linear (P<.001) and negative binomial model (P=.005). Conclusions: The real-time correlation between syndromic surveillance and COVID-19 cases on a university campus suggests symptom reporting is a viable alternative or supplement to COVID-19 surveillance testing. At the county level, syndromic surveillance is also a leading indicator of COVID-19 cases, enabling quick action to reduce transmission. Further research should investigate COVID-19 risk using syndromic surveillance in other settings, such as low-resource settings like low- and middle-income countries. UR - https://publichealth.jmir.org/2024/1/e54551 UR - http://dx.doi.org/10.2196/54551 ID - info:doi/10.2196/54551 ER - TY - JOUR AU - Kaewkungwal, Jaranit AU - Roobsoong, Wanlapa AU - Lawpoolsri, Saranath AU - Nguitragool, Wang AU - Thammapalo, Suwich AU - Prikchoo, Pathomporn AU - Khamsiriwatchara, Amnat AU - Pawarana, Rungrawee AU - Jarujareet, Pawinee AU - Parker, M. Daniel AU - Sripoorote, Piyarat AU - Kengganpanich, Mondha AU - Ngamjarus, Chetta AU - Sattabongkot, Jetsumon AU - Cui, Liwang PY - 2024/6/26 TI - Effectiveness, Safety, and Acceptability of Primaquine Mass Drug Administration in Low-Endemicity Areas in Southern Thailand: Proof-of-Concept Study JO - JMIR Public Health Surveill SP - e51993 VL - 10 KW - mass drug administration KW - cluster-crossover randomized controlled trial KW - community-based trial KW - participatory epidemiology KW - Plasmodium vivax KW - primaquine N2 - Background: A challenge in achieving the malaria-elimination target in the Greater Mekong Subregion, including Thailand, is the predominance of Plasmodium vivax malaria, which has shown extreme resilience to control measures. Objective: This proof-of-concept study aimed to provide evidence for implementing primaquine mass drug administration (pMDA) as a strategy for P. vivax elimination in low-endemicity settings. Methods: The study employed a mixed-methods trial to thoroughly evaluate the effectiveness, safety, acceptability, and community engagement of pMDA. The quantitative part was designed as a 2-period cluster-crossover randomized controlled trial. The intervention was pMDA augmented to the national prevention and control standards with directly observed treatment (DOT) by village health volunteers. The qualitative part employed in-depth interviews and brainstorming discussions. The study involved 7 clusters in 2 districts of 2 southern provinces in Thailand with persistently low P. vivax transmission. In the quantitative part, 5 cross-sectional blood surveys were conducted in both the pMDA and control groups before and 3 months after pMDA. The effectiveness of pMDA was determined by comparing the proportions of P. vivax infections per 1000 population between the 2 groups, with a multilevel zero-inflated negative binomial model adjusted for cluster and time as covariates and the interaction. The safety data comprised adverse events after drug administration. Thematic content analysis was used to assess the acceptability and engagement of stakeholders. Results: In the pre-pMDA period, the proportions of P. vivax infections in the pMDA (n=1536) and control (n=1577) groups were 13.0 (95% CI 8.2-20.4) and 12.0 (95% CI 7.5-19.1), respectively. At month 3 post-pMDA, these proportions in the pMDA (n=1430) and control (n=1420) groups were 8.4 (95% CI 4.6-15.1) and 5.6 (95% CI 2.6-11.5), respectively. No statistically significant differences were found between the groups. The number of malaria cases reduced in all clusters in both groups, and thus, the impact of pMDA was inconclusive. There were no major safety concerns. Acceptance among the study participants and public health care providers at local and national levels was high, and they believed that pMDA had boosted awareness in the community. Conclusions: pMDA was associated with high adherence, safety, and tolerability, but it may not significantly impact P. vivax transmission. As this was a proof-of-concept study, we decided not to scale up the intervention with larger clusters and samples. An alternative approach involving a targeted primaquine treatment strategy with primaquine and DOT is currently being implemented. We experienced success regarding effective health care workforces at point-of-care centers, effective collaborations in the community, and commitment from authorities at local and national levels. Our efforts boosted the acceptability of the malaria-elimination initiative. Community engagement is recommended to achieve elimination targets. Trial Registration: Thai Clinical Trials Registry TCTR20190806004; https://www.thaiclinicaltrials.org/show/TCTR20190806004 UR - https://publichealth.jmir.org/2024/1/e51993 UR - http://dx.doi.org/10.2196/51993 UR - http://www.ncbi.nlm.nih.gov/pubmed/38922648 ID - info:doi/10.2196/51993 ER - TY - JOUR AU - Ma, Shuli AU - Ge, Jie AU - Qin, Lei AU - Chen, Xiaoting AU - Du, Linlin AU - Qi, Yanbo AU - Bai, Li AU - Han, Yunfeng AU - Xie, Zhiping AU - Chen, Jiaxin AU - Jia, Yuehui PY - 2024/6/19 TI - Spatiotemporal Epidemiological Trends of Mpox in Mainland China: Spatiotemporal Ecological Comparison Study JO - JMIR Public Health Surveill SP - e57807 VL - 10 KW - mpox KW - spatiotemporal analysis KW - emergencies KW - prevention and control KW - public health N2 - Background: The World Health Organization declared mpox an international public health emergency. Since January 1, 2022, China has been ranked among the top 10 countries most affected by the mpox outbreak globally. However, there is a lack of spatial epidemiological studies on mpox, which are crucial for accurately mapping the spatial distribution and clustering of the disease. Objective: This study aims to provide geographically accurate visual evidence to determine priority areas for mpox prevention and control. Methods: Locally confirmed mpox cases were collected between June and November 2023 from 31 provinces of mainland China excluding Taiwan, Macao, and Hong Kong. Spatiotemporal epidemiological analyses, including spatial autocorrelation and regression analyses, were conducted to identify the spatiotemporal characteristics and clustering patterns of mpox attack rate and its spatial relationship with sociodemographic and socioeconomic factors. Results: From June to November 2023, a total of 1610 locally confirmed mpox cases were reported in 30 provinces in mainland China, resulting in an attack rate of 11.40 per 10 million people. Global spatial autocorrelation analysis showed that in July (Moran I=0.0938; P=.08), August (Moran I=0.1276; P=.08), and September (Moran I=0.0934; P=.07), the attack rates of mpox exhibited a clustered pattern and positive spatial autocorrelation. The Getis-Ord Gi* statistics identified hot spots of mpox attack rates in Beijing, Tianjin, Shanghai, Jiangsu, and Hainan. Beijing and Tianjin were consistent hot spots from June to October. No cold spots with low mpox attack rates were detected by the Getis-Ord Gi* statistics. Local Moran I statistics identified a high-high (HH) clustering of mpox attack rates in Guangdong, Beijing, and Tianjin. Guangdong province consistently exhibited HH clustering from June to November, while Beijing and Tianjin were identified as HH clusters from July to September. Low-low clusters were mainly located in Inner Mongolia, Xinjiang, Xizang, Qinghai, and Gansu. Ordinary least squares regression models showed that the cumulative mpox attack rates were significantly and positively associated with the proportion of the urban population (t0.05/2,1=2.4041 P=.02), per capita gross domestic product (t0.05/2,1=2.6955; P=.01), per capita disposable income (t0.05/2,1=2.8303; P=.008), per capita consumption expenditure (PCCE; t0.05/2,1=2.7452; P=.01), and PCCE for health care (t0.05/2,1=2.5924; P=.01). The geographically weighted regression models indicated a positive association and spatial heterogeneity between cumulative mpox attack rates and the proportion of the urban population, per capita gross domestic product, per capita disposable income, and PCCE, with high R2 values in north and northeast China. Conclusions: Hot spots and HH clustering of mpox attack rates identified by local spatial autocorrelation analysis should be considered key areas for precision prevention and control of mpox. Specifically, Guangdong, Beijing, and Tianjin provinces should be prioritized for mpox prevention and control. These findings provide geographically precise and visualized evidence to assist in identifying key areas for targeted prevention and control. UR - https://publichealth.jmir.org/2024/1/e57807 UR - http://dx.doi.org/10.2196/57807 UR - http://www.ncbi.nlm.nih.gov/pubmed/38896444 ID - info:doi/10.2196/57807 ER - TY - JOUR AU - Miao, Huazhang AU - He, Hui AU - Nie, Chuan AU - Ren, Jianbing AU - Luo, Xianqiong PY - 2024/6/18 TI - Spatiotemporal Characteristics and Risk Factors for All and Severity-Specific Preterm Births in Southern China, 2014-2021: Large Population-Based Study JO - JMIR Public Health Surveill SP - e48815 VL - 10 KW - preterm birth KW - spatiotemporal KW - incidence KW - risk KW - neonatal KW - infant KW - pregnancy health KW - pregnancy complication KW - pregnancy KW - birth defect KW - birth defects KW - obstetric labor KW - premature N2 - Background: The worldwide incidence of preterm births is increasing, and the risks of adverse outcomes for preterm infants significantly increase with shorter gestation, resulting in a substantial socioeconomic burden. Limited epidemiological studies have been conducted in China regarding the incidence and spatiotemporal trends of preterm births. Seasonal variations in risk indicate the presence of possible modifiable factors. Gender influences the risk of preterm birth. Objective: This study aims to assess the incidence rates of preterm birth, very preterm birth, and extremely preterm birth; elucidate their spatiotemporal distribution; and investigate the risk factors associated with preterm birth. Methods: We obtained data from the Guangdong Provincial Maternal and Child Health Information System, spanning from January 1, 2014, to December 31, 2021, pertaining to neonates with gestational ages ranging from 24 weeks to 42 weeks. The primary outcome measures assessed variations in the rates of different preterm birth subtypes over the course of the study, such as by year, region, and season. Furthermore, we examined the relationship between preterm birth incidence and per capita gross domestic product (GDP), simultaneously analyzing the contributing risk factors. Results: The analysis incorporated data from 13,256,743 live births. We identified 754,268 preterm infants and 12,502,475 full-term infants. The incidences of preterm birth, very preterm birth, and extremely preterm birth were 5.69 per 100 births, 4.46 per 1000 births, and 4.83 per 10,000 births, respectively. The overall incidence of preterm birth increased from 5.12% in 2014 to 6.38% in 2021. The incidence of extremely preterm birth increased from 4.10 per 10,000 births in 2014 to 8.09 per 10,000 births in 2021. There was a positive correlation between the incidence of preterm infants and GDP per capita. In more developed economic regions, the incidence of preterm births was higher. Furthermore, adjusted odds ratios revealed that advanced maternal age, multiple pregnancies, and male infants were associated with an increased risk of preterm birth, whereas childbirth in the autumn season was associated with a protective effect against preterm birth. Conclusions: The incidence of preterm birth in southern China exhibited an upward trend, closely linked to enhancements in the care capabilities for high-risk pregnant women and critically ill newborns. With the recent relaxation of China's 3-child policy, coupled with a temporary surge in advanced maternal age and multiple pregnancies, the risk of preterm birth has risen. Consequently, there is a pressing need to augment public health investments aimed at mitigating the risk factors associated with preterm birth, thereby alleviating the socioeconomic burden it imposes. UR - https://publichealth.jmir.org/2024/1/e48815 UR - http://dx.doi.org/10.2196/48815 UR - http://www.ncbi.nlm.nih.gov/pubmed/38888944 ID - info:doi/10.2196/48815 ER - TY - JOUR AU - Gauld, Christophe AU - Hartley, Sarah AU - Micoulaud-Franchi, Jean-Arthur AU - Royant-Parola, Sylvie PY - 2024/6/11 TI - Sleep Health Analysis Through Sleep Symptoms in 35,808 Individuals Across Age and Sex Differences: Comparative Symptom Network Study JO - JMIR Public Health Surveill SP - e51585 VL - 10 KW - symptom KW - epidemiology KW - age KW - sex KW - diagnosis KW - network approach KW - sleep KW - sleep health N2 - Background: Sleep health is a multidimensional construct that includes objective and subjective parameters and is influenced by individual sleep-related behaviors and sleep disorders. Symptom network analysis allows modeling of the interactions between variables, enabling both the visualization of relationships between different factors and the identification of the strength of those relationships. Given the known influence of sex and age on sleep health, network analysis can help explore sets of mutually interacting symptoms relative to these demographic variables. Objective: This study aimed to study the centrality of symptoms and compare age and sex differences regarding sleep health using a symptom network approach in a large French population that feels concerned about their sleep. Methods: Data were extracted from a questionnaire provided by the Réseau Morphée health network. A network analysis was conducted on 39 clinical variables related to sleep disorders and sleep health. After network estimation, statistical analyses consisted of calculating inferences of centrality, robustness (ie, testifying to a sufficient effect size), predictability, and network comparison. Sleep clinical variable centralities within the networks were analyzed by both sex and age using 4 age groups (18-30, 31-45, 46-55, and >55 years), and local symptom-by-symptom correlations determined. Results: Data of 35,808 participants were obtained. The mean age was 42.7 (SD 15.7) years, and 24,964 (69.7%) were women. Overall, there were no significant differences in the structure of the symptom networks between sexes or age groups. The most central symptoms across all groups were nonrestorative sleep and excessive daytime sleepiness. In the youngest group, additional central symptoms were chronic circadian misalignment and chronic sleep deprivation (related to sleep behaviors), particularly among women. In the oldest group, leg sensory discomfort and breath abnormality complaint were among the top 4 central symptoms. Symptoms of sleep disorders thus became more central with age than sleep behaviors. The high predictability of central nodes in one of the networks underlined its importance in influencing other nodes. Conclusions: The absence of structural difference between networks is an important finding, given the known differences in sleep between sexes and across age groups. These similarities suggest comparable interactions between clinical sleep variables across sexes and age groups and highlight the implication of common sleep and wake neural circuits and circadian rhythms in understanding sleep health. More precisely, nonrestorative sleep and excessive daytime sleepiness are central symptoms in all groups. The behavioral component is particularly central in young people and women. Sleep-related respiratory and motor symptoms are prominent in older people. These results underscore the importance of comprehensive sleep promotion and screening strategies tailored to sex and age to impact sleep health. UR - https://publichealth.jmir.org/2024/1/e51585 UR - http://dx.doi.org/10.2196/51585 UR - http://www.ncbi.nlm.nih.gov/pubmed/38861716 ID - info:doi/10.2196/51585 ER - TY - JOUR AU - Lee, Jun Jae AU - Lee, Hee Kyung PY - 2024/6/11 TI - Optimal Systolic Blood Pressure for the Prevention of All-Cause and Cardiovascular Disease Mortality in Older Adults With Hypertension: Nationwide Population-Based Cohort Study JO - JMIR Public Health Surveill SP - e52182 VL - 10 KW - aged KW - blood pressure KW - cardiovascular diseases KW - hypertension KW - mortality KW - older adults KW - geriatric KW - elderly KW - cardiovascular KW - Korea KW - Korean KW - insurance KW - cohort study KW - systolic KW - risk KW - aging KW - health outcome N2 - Background: Target systolic blood pressure (SBP) levels for older adults with hypertension vary across countries, leading to challenges in determining the appropriate SBP level. Objective: This study aims to identify the optimal SBP level for minimizing all-cause and cardiovascular disease (CVD) mortality in older Korean adults with hypertension. Methods: This retrospective cohort study used data from the National Health Insurance Service database. We included older adults aged 65 years or older who were newly diagnosed with hypertension and underwent a National Health Insurance Service health checkup in 2003-2004. We excluded patients who had a history of hypertension or CVD, were not prescribed medication for hypertension, had missing blood pressure or any other covariate values, and had fewer than 2 health checkups during the follow-up period until 2020. We categorized the average SBP levels into 6 categories in 10 mm Hg increments, from <120 mm Hg to ?160 mm Hg; 130-139 mm Hg was the reference range. Cox proportional hazards models were used to examine the relationship between SBP and all-cause and CVD mortalities, and subgroup analysis was conducted by age group (65-74 years and 75 years or older). Results: A total of 68,901 older adults newly diagnosed with hypertension were included in this study. During the follow-up period, 32,588 (47.3%) participants had all-cause mortality and 4273 (6.2%) had CVD mortality. Compared to older adults with SBP within the range of 130-139 mm Hg, individuals who fell into the other SBP categories, excluding those with SBP 120-129 mm Hg, showed significantly higher all-cause and CVD mortality. Subgroup analysis showed that older adults aged 65-74 years had higher all-cause and CVD mortality rates according to SBP categories than those aged 75 years or older. Conclusions: The SBP levels within the range of 120-139 mm Hg were associated with the lowest all-cause and CVD mortality rates among older Korean adults with hypertension. It is recommended to reduce SBP to <140 mm Hg, with 120 mm Hg as the minimum value for SBP, for older Korean adults with hypertension. Additionally, stricter SBP management is required for adults aged 65-74 years. UR - https://publichealth.jmir.org/2024/1/e52182 UR - http://dx.doi.org/10.2196/52182 UR - http://www.ncbi.nlm.nih.gov/pubmed/38861307 ID - info:doi/10.2196/52182 ER - TY - JOUR AU - Hong, Chong Hye AU - Kim, Man Young PY - 2024/6/10 TI - Multimorbidity and its Associated Factors in Korean Shift Workers: Population-Based Cross-Sectional Study JO - JMIR Public Health Surveill SP - e55014 VL - 10 KW - chronic disease KW - multimorbidity KW - shift work schedule KW - shift workers KW - population-based study KW - Korea KW - network analysis KW - logistic regression KW - cross-sectional study KW - public health N2 - Background: Multimorbidity is a crucial factor that influences premature death rates, poor health, depression, quality of life, and use of health care. Approximately one-fifth of the global workforce is involved in shift work, which is associated with increased risk for several chronic diseases and multimorbidity. About 12% to 14% of wage workers in Korea are shift workers. However, the prevalence of multimorbidity and its associated factors in Korean shift workers are rarely reported. Objective: This study aimed to assess multimorbidity prevalence, examine the factors associated with multimorbidity, and identify multimorbidity patterns among shift workers in Korea. Methods: This study is a population-based cross-sectional study using Korea National Health and Nutrition Examination Survey data from 2016 to 2020. The study included 1704 (weighted n=2,697,228) Korean shift workers aged 19 years and older. Multimorbidity was defined as participants having 2 or more chronic diseases. Demographic and job-related variables, including regular work status, average working hours per week, and shift work type, as well as health behaviors, including BMI, smoking status, alcohol use, physical activity, and sleep duration, were included in the analysis. A survey-corrected logistic regression analysis was performed to identify factors influencing multimorbidity among the workers, and multimorbidity patterns were identified with a network analysis. Results: The overall prevalence of multimorbidity was 13.7% (302/1704). Logistic regression indicated that age, income, regular work, and obesity were significant factors influencing multimorbidity. Network analysis results revealed that chronic diseases clustered into three groups: (1) cardiometabolic multimorbidity (hypertension, dyslipidemia, diabetes, coronary heart disease, and stroke), (2) musculoskeletal multimorbidity (arthritis and osteoporosis), and (3) unclassified diseases (depression, chronic liver disease, thyroid disease, asthma, cancer, and chronic kidney disease). Conclusions: The findings revealed that several socioeconomic and behavioral factors were associated with multimorbidity among shift workers, indicating the need for policy development related to work schedule modification. Further organization-level screening and intervention programs are needed to prevent and manage multimorbidity among shift workers. We also recommend longitudinal studies to confirm the effects of job-related factors and health behaviors on multimorbidity among shift workers in the future. UR - https://publichealth.jmir.org/2024/1/e55014 UR - http://dx.doi.org/10.2196/55014 UR - http://www.ncbi.nlm.nih.gov/pubmed/38857074 ID - info:doi/10.2196/55014 ER - TY - JOUR AU - Huang, Xuefeng AU - Kong, Qian-Yi AU - Wan, Xiaowen AU - Huang, Yating AU - Wang, Rongrong AU - Wang, Xiaoxue AU - Li, Yingying AU - Wu, Yuqing AU - Guan, Chongyuan AU - Wang, Junyang AU - Zhang, Yuanyuan PY - 2024/6/10 TI - From the Public Health Perspective: a Scalable Model for Improving Epidemiological Testing Efficacy in Low- and Middle-Income Areas JO - JMIR Public Health Surveill SP - e55194 VL - 10 KW - low- and middle-income country KW - LMIC KW - pandemic KW - epidemiological surveillance KW - universal public health KW - nonpharmacological interventions KW - public health KW - callable model KW - efficacy KW - COVID-19 KW - public safety threats KW - effectiveness KW - China KW - detection KW - epidemic UR - https://publichealth.jmir.org/2024/1/e55194 UR - http://dx.doi.org/10.2196/55194 UR - http://www.ncbi.nlm.nih.gov/pubmed/38857063 ID - info:doi/10.2196/55194 ER - TY - JOUR AU - Xie, Ziyi AU - Chen, Bowen AU - Duan, Zhizhuang PY - 2024/6/7 TI - Spatiotemporal Analysis of HIV/AIDS Incidence in China From 2009 to 2019 and Its Association With Socioeconomic Factors: Geospatial Study JO - JMIR Public Health Surveill SP - e56229 VL - 10 KW - HIV/AIDS KW - spatiotemporal distribution KW - cluster analysis KW - socioeconomic factors KW - China N2 - Background: The Joint United Nations Program on HIV/AIDS (UNAIDS) has set the ?95-95-95? targets to ensure that 95% of all people living with HIV will know their HIV status, 95% of all people living with HIV will receive sustained antiretroviral therapy (ART), and 95% of all people receiving ART will achieve viral suppression (<1000 copies/mL). However, few countries have currently achieved these targets, posing challenges to the realization of the UNAIDS goal to eliminate the global HIV/AIDS epidemic by 2030. The Chinese government has implemented corresponding policies for HIV/AIDS prevention and control; however, it still faces the challenge of a large number of HIV/AIDS cases. Existing research predominantly focuses on the study of a particular region or population in China, and there is relatively limited research on the macro-level analysis of the spatiotemporal distribution of HIV/AIDS across China and its association with socioeconomic factors. Objective: This study seeks to identify the impact of these factors on the spatiotemporal distribution of HIV/AIDS incidence in China, aiming to provide scientific recommendations for future policy development. Methods: This study employed ArcGIS 10.2 (Esri) for spatial analysis, encompassing measures such as the imbalance index, geographical concentration index, spatial autocorrelation analysis (Moran I), and hot spot analysis (Getis-Ord Gi*). These methods were used to unveil the spatiotemporal distribution characteristics of HIV/AIDS incidence in 31 provinces of China from 2009 to 2019. Geographical Detector was used for ecological detection, risk area detection, factor detection, and interaction detection. The analysis focused on 9 selected socioeconomic indicators to further investigate the influence of socioeconomic factors on HIV/AIDS incidence in China. Results: The spatiotemporal distribution analysis of HIV/AIDS incidence in China from 2009 to 2019 revealed distinct patterns. The spatial distribution type of HIV/AIDS incidence in China was random in 2009-2010. However, from 2011 to 2019, the distribution pattern evolved toward a clustered arrangement, with the degree of clustering increasing each year. Notably, from 2012 onwards, there was a significant and rapid growth in the aggregation of cold and hot spot clusters of HIV/AIDS incidence in China, stabilizing only by the year 2016. An analysis of the impact of socioeconomic factors on HIV/AIDS incidence in China highlighted the ?urbanization rate? and ?urban basic medical insurance fund expenditure? as the primary factors influencing the spatial distribution of HIV/AIDS incidence. Additionally, among social factors, indicators related to medical resources exerted a crucial influence on HIV/AIDS incidence. Conclusions: From 2009 to 2019, HIV/AIDS incidence in China was influenced by various socioeconomic factors. In the future, it is imperative to optimize the combination of different socioeconomic indicators based on regional incidence patterns. This optimization will facilitate the formulation of corresponding policies to address the challenges posed by the HIV/AIDS epidemic. UR - https://publichealth.jmir.org/2024/1/e56229 UR - http://dx.doi.org/10.2196/56229 UR - http://www.ncbi.nlm.nih.gov/pubmed/38848123 ID - info:doi/10.2196/56229 ER - TY - JOUR AU - Ormiston, K. Cameron AU - Villalobos, Kevin AU - Montiel Ishino, Alejandro Francisco AU - Williams, Faustine PY - 2024/6/6 TI - Association Between Discrimination and Depressive Symptoms Among Hispanic or Latino Adults During the COVID-19 Pandemic: Cross-Sectional Study JO - JMIR Form Res SP - e48076 VL - 8 KW - depressive symptoms KW - everyday discrimination KW - COVID-19 pandemic KW - Hispanic and Latino KW - immigrant health N2 - Background: Discrimination and xenophobia toward Hispanic and Latino communities increased during the COVID-19 pandemic, likely inflicting significant harm on the mental health of Hispanic and Latino individuals. Pandemic-related financial and social instability has disproportionately affected Hispanic and Latino communities, potentially compounding existing disparities and worsening mental health. Objective: This study aims to examine the association between discrimination and depressive symptoms during the COVID-19 pandemic among a national sample of Hispanic and Latino adults. Methods: Data from a 116-item web-based nationally distributed survey from May 2021 to January 2022 were analyzed. The sample (N=1181) was restricted to Hispanic or Latino (Mexican or Mexican American, Puerto Rican; Cuban or Cuban American, Central or South American, and Dominican or another Hispanic or Latino ethnicity) adults. Depression symptoms were assessed using the 2-item Patient Health Questionnaire. Discrimination was assessed using the 5-item Everyday Discrimination Scale. A multinomial logistic regression with a block entry model was used to assess the relationship between discrimination and the likelihood of depressive symptoms, as well as examine how controls and covariates affected the relationship of interest. Results: Mexican or Mexican American adults comprised the largest proportion of the sample (533/1181, 45.13%), followed by Central or South American (204/1181, 17.3%), Puerto Rican (189/1181, 16%), Dominican or another Hispanic or Latino ethnicity (172/1181, 14.6%), and Cuban or Cuban American (83/1181, 7.03%). Approximately 31.26% (367/1181) of the sample had depressive symptoms. Regarding discrimination, 54.56% (634/1181) reported experiencing some form of discrimination. Compared with those who did not experience discrimination, those who experienced discrimination had almost 230% higher odds of depressive symptoms (adjusted odds ratio [AOR] 3.31, 95% CI 2.42-4.54). Also, we observed that sociodemographic factors such as age and gender were significant. Compared with participants aged 56 years and older, participants aged 18-35 years and those aged 36-55 years had increased odds of having depressive symptoms (AOR 3.83, 95% CI 2.13-6.90 and AOR 3.10, 95% CI 1.74-5.51, respectively). Women had higher odds of having depressive symptoms (AOR 1.67, 95% CI 1.23-2.30) than men. Respondents with an annual income of less than US $25,000 (AOR 2.14, 95% CI 1.34-3.41) and US $25,000 to less than US $35,000 (AOR 1.89, 95% CI 1.17-3.06) had higher odds of depressive symptoms than those with an annual income of US $50,000 to less than US $75,000. Conclusions: Our findings provide significant importance especially when considering the compounding, numerous socioeconomic challenges stemming from the pandemic that disproportionately impact the Hispanic and Latino communities. These challenges include rising xenophobia and tensions against immigrants, inadequate access to mental health resources for Hispanic and Latino individuals, and existing hesitations toward seeking mental health services among this population. Ultimately, these findings can serve as a foundation for promoting health equity. UR - https://formative.jmir.org/2024/1/e48076 UR - http://dx.doi.org/10.2196/48076 UR - http://www.ncbi.nlm.nih.gov/pubmed/38843512 ID - info:doi/10.2196/48076 ER - TY - JOUR AU - Luo, Yizhe AU - Zhang, Longyao AU - Xu, Yameng AU - Kuai, Qiyuan AU - Li, Wenhao AU - Wu, Yifan AU - Liu, Licheng AU - Ren, Jiarong AU - Zhang, Lingling AU - Shi, Qiufang AU - Liu, Xiaobo AU - Tan, Weilong PY - 2024/6/5 TI - Epidemic Characteristics and Meteorological Risk Factors of Hemorrhagic Fever With Renal Syndrome in 151 Cities in China From 2015 to 2021: Retrospective Analysis JO - JMIR Public Health Surveill SP - e52221 VL - 10 KW - China KW - hemorrhagic fever with renal syndrome KW - HFRS KW - climate change KW - meteorological factors KW - distributed lag nonlinear model N2 - Background: Hemorrhagic fever with renal syndrome (HFRS) continues to pose a significant public health threat to the population in China. Previous epidemiological evidence indicates that HFRS is climate sensitive and influenced by meteorological factors. However, past studies either focused on too-narrow geographical regions or investigated time periods that were too early. There is an urgent need for a comprehensive analysis to interpret the epidemiological patterns of meteorological factors affecting the incidence of HFRS across diverse climate zones. Objective: In this study, we aimed to describe the overall epidemic characteristics of HFRS and explore the linkage between monthly HFRS cases and meteorological factors at different climate levels in China. Methods: The reported HFRS cases and meteorological data were collected from 151 cities in China during the period from 2015 to 2021. We conducted a 3-stage analysis, adopting a distributed lag nonlinear model and a generalized additive model to estimate the interactions and marginal effects of meteorological factors on HFRS. Results: This study included a total of 63,180 cases of HFRS; the epidemic trends showed seasonal fluctuations, with patterns varying across different climate zones. Temperature had the greatest impact on the incidence of HFRS, with the maximum hysteresis effects being at 1 month (?19 ºC; relative risk [RR] 1.64, 95% CI 1.24-2.15) in the midtemperate zone, 0 months (28 ºC; RR 3.15, 95% CI 2.13-4.65) in the warm-temperate zone, and 0 months (4 ºC; RR 1.72, 95% CI 1.31-2.25) in the subtropical zone. Interactions were discovered between the average temperature, relative humidity, and precipitation in different temperature zones. Moreover, the influence of precipitation and relative humidity on the incidence of HFRS had different characteristics under different temperature layers. The hysteresis effect of meteorological factors did not end after an epidemic season, but gradually weakened in the following 1 or 2 seasons. Conclusions: Weather variability, especially low temperature, plays an important role in epidemics of HFRS in China. A long hysteresis effect indicates the necessity of continuous intervention following an HFRS epidemic. This finding can help public health departments guide the prevention and control of HFRS and develop strategies to cope with the impacts of climate change in specific regions. UR - https://publichealth.jmir.org/2024/1/e52221 UR - http://dx.doi.org/10.2196/52221 UR - http://www.ncbi.nlm.nih.gov/pubmed/38837197 ID - info:doi/10.2196/52221 ER - TY - JOUR AU - Talanki, Sri Ananya AU - Bajaj, Neha AU - Trehan, Twinkle AU - Thirunavukkarasu, Sathish PY - 2024/6/4 TI - Incidence, Risk, and Clinical Course of New-Onset Diabetes in Long COVID: Protocol for a Systematic Review and Meta-Analysis of Cohort Studies JO - JMIR Res Protoc SP - e54853 VL - 13 KW - COVID-19 KW - SARS-CoV-2 KW - type 1 diabetes KW - type 2 diabetes KW - new-onset diabetes KW - long COVID KW - incidence KW - cohort studies KW - postacute sequela KW - systematic review KW - meta-analysis N2 - Background: COVID-19, an infectious disease pandemic, affected millions of people globally, resulting in high morbidity and mortality. Causing further concern, significant proportions of COVID-19 survivors endure the lingering health effects of SARS-CoV-2, the pathogen that causes COVID-19. One of the diseases manifesting as a postacute sequela of COVID-19 (also known as ?long COVID?) is new-onset diabetes. Objective: The aim of this study is to examine the incidence of new-onset diabetes in patients with long COVID and assess the excess risk compared with individuals who tested negative for COVID-19. The study also aims to estimate the population-attributable fraction for COVID-19 as a risk factor for new-onset diabetes in long COVID and investigate the clinical course of new-onset diabetes cases. Methods: This is a protocol for a systematic review and meta-analysis. PubMed, MEDLINE, Embase, Scopus, and Web of Science databases will be systematically searched to identify articles published between December 2019 and July 2024. A comprehensive search strategy for each database will be developed using a combination of Medical Subject Headings terms, subject headings, and text words to identify eligible studies. Cohort studies and randomized controlled trials (only control arms) involving patients with COVID-19 of any age, with follow-up data on new-onset diabetes in long COVID, will be considered for inclusion. Controls will comprise individuals who tested negative for COVID-19, with or without other respiratory tract infections. Three independent reviewers (AST, NB, and TT) will perform article selection, data extraction, and quality assessment of the studies. A fourth reviewer (ST) will review the identified studies for final inclusion in the analysis. The random-effects DerSimonian-Laird models will be used to estimate the pooled incidence proportion (%), incidence rate of diabetes (per 1000 person-years), and risk ratio (with 95% CIs) for diabetes incidence. Results: A total of 1972 articles were identified through the initial search conducted in August 2023. After excluding duplicates, conducting title and abstract screening, and completing full-text reviews, 41 articles were found to be eligible for inclusion. The search will be updated in July 2024. Currently, data extraction is underway, and the meta-analysis is expected to be completed in August 2024. Publication of the study findings is anticipated by the end of 2024. Conclusions: The study findings should provide valuable insights to inform both clinical practice and public health policies regarding the effective management of new-onset diabetes in patients with long COVID. International Registered Report Identifier (IRRID): DERR1-10.2196/54853 UR - https://www.researchprotocols.org/2024/1/e54853 UR - http://dx.doi.org/10.2196/54853 UR - http://www.ncbi.nlm.nih.gov/pubmed/38833277 ID - info:doi/10.2196/54853 ER - TY - JOUR AU - Tran, D. Amanda AU - White, E. Alice AU - Torok, R. Michelle AU - Jervis, H. Rachel AU - Albanese, A. Bernadette AU - Scallan Walter, J. Elaine PY - 2024/5/27 TI - Lessons Learned From a Sequential Mixed-Mode Survey Design to Recruit and Collect Data From Case-Control Study Participants: Formative Evaluation JO - JMIR Form Res SP - e56218 VL - 8 KW - case-control studies KW - mixed-mode design KW - epidemiologic study methods KW - web-based survey KW - telephone interview KW - public health KW - outbreak preparedness KW - COVID-19 KW - survey KW - recruitment KW - epidemiology KW - methods N2 - Background: Sequential mixed-mode surveys using both web-based surveys and telephone interviews are increasingly being used in observational studies and have been shown to have many benefits; however, the application of this survey design has not been evaluated in the context of epidemiological case-control studies. Objective: In this paper, we discuss the challenges, benefits, and limitations of using a sequential mixed-mode survey design for a case-control study assessing risk factors during the COVID-19 pandemic. Methods: Colorado adults testing positive for SARS-CoV-2 were randomly selected and matched to those with a negative SARS-CoV-2 test result from March to April 2021. Participants were first contacted by SMS text message to complete a self-administered web-based survey asking about community exposures and behaviors. Those who did not respond were contacted for a telephone interview. We evaluated the representativeness of survey participants to sample populations and compared sociodemographic characteristics, participant responses, and time and resource requirements by survey mode using descriptive statistics and logistic regression models. Results: Of enrolled case and control participants, most were interviewed by telephone (308/537, 57.4% and 342/648, 52.8%, respectively), with overall enrollment more than doubling after interviewers called nonresponders. Participants identifying as female or White non-Hispanic, residing in urban areas, and not working outside the home were more likely to complete the web-based survey. Telephone participants were more likely than web-based participants to be aged 18-39 years or 60 years and older and reside in areas with lower levels of education, more linguistic isolation, lower income, and more people of color. While there were statistically significant sociodemographic differences noted between web-based and telephone case and control participants and their respective sample pools, participants were more similar to sample pools when web-based and telephone responses were combined. Web-based participants were less likely to report close contact with an individual with COVID-19 (odds ratio [OR] 0.70, 95% CI 0.53-0.94) but more likely to report community exposures, including visiting a grocery store or retail shop (OR 1.55, 95% CI 1.13-2.12), restaurant or cafe or coffee shop (OR 1.52, 95% CI 1.20-1.92), attending a gathering (OR 1.69, 95% CI 1.34-2.15), or sport or sporting event (OR 1.05, 95% CI 1.05-1.88). The web-based survey required an average of 0.03 (SD 0) person-hours per enrolled participant and US $920 in resources, whereas the telephone interview required an average of 5.11 person-hours per enrolled participant and US $70,000 in interviewer wages. Conclusions: While we still encountered control recruitment challenges noted in other observational studies, the sequential mixed-mode design was an efficient method for recruiting a more representative group of participants for a case-control study with limited impact on data quality and should be considered during public health emergencies when timely and accurate exposure information is needed to inform control measures. UR - https://formative.jmir.org/2024/1/e56218 UR - http://dx.doi.org/10.2196/56218 UR - http://www.ncbi.nlm.nih.gov/pubmed/38801768 ID - info:doi/10.2196/56218 ER - TY - JOUR AU - Post, Ann Lori AU - Wu, A. Scott AU - Soetikno, G. Alan AU - Ozer, A. Egon AU - Liu, Yingxuan AU - Welch, B. Sarah AU - Hawkins, Claudia AU - Moss, B. Charles AU - Murphy, L. Robert AU - Mason, Maryann AU - Havey, J. Robert AU - Lundberg, L. Alexander PY - 2024/5/17 TI - Updated Surveillance Metrics and History of the COVID-19 Pandemic (2020-2023) in Latin America and the Caribbean: Longitudinal Trend Analysis JO - JMIR Public Health Surveill SP - e44398 VL - 10 KW - SARS-CoV-2 KW - COVID-19 KW - Latin America KW - Caribbean KW - pandemic KW - surveillance KW - COVID-19 transmission KW - speed KW - acceleration KW - deceleration KW - jerk KW - dynamic panel KW - generalized method of moments KW - GMM KW - Arellano-Bond KW - 7-day lag KW - epidemiological KW - genomic KW - transmission N2 - Background: In May 2020, the World Health Organization (WHO) declared Latin America and the Caribbean (LAC) the epicenter of the COVID-19 pandemic, with over 40% of worldwide COVID-19?related deaths at the time. This high disease burden was a result of the unique circumstances in LAC. Objective: This study aimed to (1) measure whether the pandemic was expanding or contracting in LAC when the WHO declared the end of COVID-19 as a public health emergency of international concern on May 5, 2023; (2) use dynamic and genomic surveillance methods to describe the history of the pandemic in the region and situate the window of the WHO declaration within the broader history; and (3) provide, with a focus on prevention policies, a historical context for the course of the pandemic in the region. Methods: In addition to updates of traditional surveillance data and dynamic panel estimates from the original study, we used data on sequenced SARS-CoV-2 variants from the Global Initiative on Sharing All Influenza Data (GISAID) to identify the appearance and duration of variants of concern (VOCs). We used Nextclade nomenclature to collect clade designations from sequences and Pangolin nomenclature for lineage designations of SARS-CoV-2. Additionally, we conducted a 1-sided t test for whether the regional weekly speed (rate of novel COVID-19 transmission) was greater than an outbreak threshold of 10. We ran the test iteratively with 6 months of data across the period from August 2020 to May 2023. Results: The speed of pandemic spread for the region had remained below the outbreak threshold for 6 months by the time of the WHO declaration. Acceleration and jerk were also low and stable. Although the 1- and 7-day persistence coefficients remained statistically significant for the 120-day period ending on the week of May 5, 2023, the coefficients were relatively modest in magnitude (0.457 and 0.491, respectively). Furthermore, the shift parameters for either of the 2 most recent weeks around May 5, 2023, did not indicate any change in this clustering effect of cases on future cases. From December 2021 onward, Omicron was the predominant VOC in sequenced viral samples. The rolling t test of speed=10 became entirely insignificant from January 2023 onward. Conclusions: Although COVID-19 continues to circulate in LAC, surveillance data suggest COVID-19 is endemic in the region and no longer reaches the threshold of the pandemic definition. However, the region experienced a high COVID-19 burden in the early stages of the pandemic, and prevention policies should be an immediate focus in future pandemics. Ahead of vaccination development, these policies can include widespread testing of individuals and an epidemiological task force with a contact-tracing system. UR - https://publichealth.jmir.org/2024/1/e44398 UR - http://dx.doi.org/10.2196/44398 UR - http://www.ncbi.nlm.nih.gov/pubmed/38568194 ID - info:doi/10.2196/44398 ER - TY - JOUR AU - Chen, Li AU - Wang, Liping AU - Xing, Yi AU - Xie, Junqing AU - Su, Binbin AU - Geng, Mengjie AU - Ren, Xiang AU - Zhang, Yi AU - Liu, Jieyu AU - Ma, Tao AU - Chen, Manman AU - Miller, E. Jessica AU - Dong, Yanhui AU - Song, Yi AU - Ma, Jun AU - Sawyer, Susan PY - 2024/5/15 TI - Persistence and Variation of the Indirect Effects of COVID-19 Restrictions on the Spectrum of Notifiable Infectious Diseases in China: Analysis of National Surveillance Among Children and Adolescents From 2018 to 2021 JO - JMIR Public Health Surveill SP - e47626 VL - 10 KW - children and adolescents KW - COVID-19 KW - notifiable infectious diseases N2 - Background: Beyond the direct effect of COVID-19 infection on young people, the wider impact of the pandemic on other infectious diseases remains unknown. Objective: This study aims to assess changes in the incidence and mortality of 42 notifiable infectious diseases during the pandemic among children and adolescents in China, compared with prepandemic levels. Methods: The Notifiable Infectious Disease Surveillance System of China was used to detect new cases and fatalities among individuals aged 5-22 years across 42 notifiable infectious diseases spanning from 2018 to 2021. These infectious diseases were categorized into 5 groups: respiratory, gastrointestinal and enterovirus, sexually transmitted and blood-borne, zoonotic, and vector-borne diseases. Each year (2018-2021) was segmented into 4 phases: phase 1 (January 1-22), phase 2 (January 23-April 7), phase 3 (April 8-August 31), and phase 4 (September 1-December 31) according to the varying intensities of pandemic restrictive measures in 2020. Generalized linear models were applied to assess the change in the incidence and mortality within each disease category, using 2018 and 2019 as the reference. Results: A total of 4,898,260 incident cases and 3701 deaths were included. The overall incidence of notifiable infectious diseases decreased sharply during the first year of the COVID-19 pandemic (2020) compared with prepandemic levels (2018 and 2019), and then rebounded in 2021, particularly in South China. Across the past 4 years, the number of deaths steadily decreased. The incidence of diseases rebounded differentially by the pandemic phase. For instance, although seasonal influenza dominated respiratory diseases in 2019, it showed a substantial decline during the pandemic (percent change in phase 2 2020: 0.21, 95% CI 0.09-0.50), which persisted until 2021 (percent change in phase 4 2021: 1.02, 95% CI 0.74-1.41). The incidence of gastrointestinal and enterovirus diseases decreased by 33.6% during 2020 but rebounded by 56.9% in 2021, mainly driven by hand, foot, and mouth disease (percent change in phase 3 2021: 1.28, 95% CI 1.17-1.41) and infectious diarrhea (percent change in phase 3 2020: 1.22, 95% CI 1.17-1.28). Sexually transmitted and blood-borne diseases were restrained during the first year of 2021 but rebounded quickly in 2021, mainly driven by syphilis (percent change in phase 3 2020: 1.31, 95% CI 1.23-1.40) and gonorrhea (percent change in phase 3 2020: 1.10, 95% CI 1.05-1.16). Zoonotic diseases were not dampened by the pandemic but continued to increase across the study period, mainly due to brucellosis (percent change in phase 2 2020: 0.94, 95% CI 0.75-1.16). Vector-borne diseases showed a continuous decline during 2020, dominated by hemorrhagic fever (percent change in phase 2 2020: 0.68, 95% CI 0.53-0.87), but rebounded in 2021. Conclusions: The COVID-19 pandemic was associated with a marked decline in notifiable infectious diseases in Chinese children and adolescents. These effects were not sustained, with evidence of a rebound to prepandemic levels by late 2021. To effectively address the postpandemic resurgence of infectious diseases in children and adolescents, it will be essential to maintain disease surveillance and strengthen the implementation of various initiatives. These include extending immunization programs, prioritizing the management of sexually transmitted infections, continuing feasible nonpharmaceutical intervention projects, and effectively managing imported infections. UR - https://publichealth.jmir.org/2024/1/e47626 UR - http://dx.doi.org/10.2196/47626 UR - http://www.ncbi.nlm.nih.gov/pubmed/38748469 ID - info:doi/10.2196/47626 ER - TY - JOUR AU - Major, G. Chelsea AU - Rodríguez, M. Dania AU - Sánchez-González, Liliana AU - Rodríguez-Estrada, Vanessa AU - Morales-Ortíz, Tatiana AU - Torres, Carolina AU - Pérez-Rodríguez, M. Nicole AU - Medina-Lópes, A. Nicole AU - Alexander, Neal AU - Mabey, David AU - Ryff, Kyle AU - Tosado-Acevedo, Rafael AU - Muñoz-Jordán, Jorge AU - Adams, E. Laura AU - Rivera-Amill, Vanessa AU - Rolfes, Melissa AU - Paz-Bailey, Gabriela PY - 2024/4/19 TI - Investigating SARS-CoV-2 Incidence and Morbidity in Ponce, Puerto Rico: Protocol and Baseline Results From a Community Cohort Study JO - JMIR Res Protoc SP - e53837 VL - 13 KW - cohort studies KW - COVID-19 KW - epidemiologic studies KW - Hispanic or Latino KW - incidence KW - prospective studies KW - research methodology KW - SARS-CoV-2 KW - seroprevalence N2 - 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 UR - https://www.researchprotocols.org/2024/1/e53837 UR - http://dx.doi.org/10.2196/53837 UR - http://www.ncbi.nlm.nih.gov/pubmed/38640475 ID - info:doi/10.2196/53837 ER - TY - JOUR AU - Cheng, Wei AU - Xu, Yun AU - Jiang, Haibo AU - Li, Jun AU - Hou, Zhigang AU - Meng, Haibin AU - Wang, Wei AU - Chai, Chengliang AU - Jiang, Jianmin PY - 2024/4/17 TI - SARS-CoV-2 Infection, Hospitalization, and Associated Factors Among People Living With HIV in Southeastern China From December 2022 to February 2023: Cross-Sectional Survey JO - JMIR Public Health Surveill SP - e51449 VL - 10 KW - associated factors KW - COVID-19 KW - hospitalization KW - infection KW - people living with HIV KW - SARS-CoV-2 Omicron variant N2 - Background: Limited studies have explored the impact of the Omicron variant on SARS-CoV-2 infection, hospitalization, and associated factors among people living with HIV, particularly in China. The adjustment of preventive policies since December 2022 in China presents an opportunity to evaluate the real-world factors influencing SARS-CoV-2 infection and related hospitalization among people living with HIV. Objective: This study aimed to investigate SARS-CoV-2 infection, hospitalization rates, and associated factors among people living with HIV following the adjustment of preventive policies from December 2022 to February 2023 in southeastern China. Methods: A cross-sectional telephone or web-based survey was conducted among people living with HIV in 5 cities in southeastern China from December 2022 to February 2023. Demographic information, SARS-CoV-2 infection and related hospitalization, and HIV-specific characteristics were collected from existing databases and special investigations. Multivariate logistic regression analyses were conducted to determine the associated factors for infection and hospitalization rates of SARS-CoV-2. Additionally, subgroup analyses were conducted for the association between vaccination and infection across different vaccination statuses and time since the last vaccination. Results: Among people living with HIV with a COVID-19 testing history, the SARS-CoV-2 infection rate was 67.13% (95% CI 65.81%-68.13%), whereas the hospitalization rate was 0.71% (95% CI 0.46%-0.97%). Factors such as age, latest CD4 cell count, latest HIV viral load, and transmission route were found to be associated with SARS-CoV-2 infection, while age, cancer, latest CD4 cell count, and latest HIV viral load were associated with SARS-CoV-2 hospitalization. In terms of SARS-CoV-2 vaccination, compared to unvaccinated people living with HIV, there was a lower infection rate among those who had been vaccinated for <3 months in the booster vaccination group (adjusted odds ratio [aOR] 0.72, 95% CI 0.53-0.98; P=.04); and there was also a lower risk of hospitalization among people living with HIV who had received vaccination in the past 6-12 months (aOR 0.33, 95% CI 0.14-0.81; P=.02) and more than 12 months ago (aOR 0.22, 95% CI 0.07-0.72; P=.01). Conclusions: After the ease of prevention and control measures in China, we observed a high SARS-CoV-2 infection rate but a low hospitalization rate. General risk factors, such as higher age and vaccination status, and HIV-related parameters, such as the latest CD4 cell count and HIV viral load, were associated with SARS-CoV-2 infection and hospitalization. A booster vaccination campaign for booster doses should be considered among people living with HIV in confronting possible COVID-19 epidemic emergencies in the near future. UR - https://publichealth.jmir.org/2024/1/e51449 UR - http://dx.doi.org/10.2196/51449 UR - http://www.ncbi.nlm.nih.gov/pubmed/38630534 ID - info:doi/10.2196/51449 ER - TY - JOUR AU - Awindaogo, Felix AU - Acheamfour-Akowuah, Emmanuel AU - Doku, Alfred AU - Kokuro, Collins AU - Agyekum, Francis AU - Owusu, Kofi Isaac PY - 2024/4/8 TI - Assessing and Improving the Care of Patients With Heart Failure in Ghana: Protocol for a Prospective Observational Study and the Ghana Heart Initiative-Heart Failure Registry JO - JMIR Res Protoc SP - e52616 VL - 13 KW - clinical KW - cross-sectional KW - epidemiology KW - Ghana KW - heart failure KW - heart KW - management KW - medium-term KW - monitoring KW - mortality KW - outcome KW - patient data KW - prevention KW - protocol KW - teaching KW - treatment N2 - Background: Heart failure (HF) is a leading cause of morbidity and mortality globally, with a high disease burden. The prevalence of HF in Ghana is increasing rapidly, but epidemiological profiles, treatment patterns, and survival data are scarce. The national capacity to diagnose and manage HF appropriately is also limited. To address the growing epidemic of HF, it is crucial to recognize the epidemiological characteristics and medium-term outcomes of HF in Ghana and improve the capability to identify and manage HF promptly and effectively at all levels of care. Objective: This study aims to determine the epidemiological characteristics and medium-term HF outcomes in Ghana. Methods: We conducted a prospective, multicenter, multilevel cross-sectional observational study of patients with HF from January to December 2023. Approximately 5000 patients presenting with HF to 9 hospitals, including teaching, regional, and municipal hospitals, will be recruited and evaluated according to a standardized protocol, including the use of an echocardiogram and an N-terminal pro-brain natriuretic peptide (NT-proBNP) test. Guideline-directed medical treatment of HF will be initiated for 6 months, and the medium-term outcomes of interventions, including rehospitalization and mortality, will be assessed. Patient data will be collated into a HF registry for continuous assessment and monitoring. Results: This intervention will generate the necessary information on the etiology of HF, clinical presentations, the diagnostic yield of various tools, and management outcomes. In addition, it will build the necessary capacity and support for HF management in Ghana. As of July 30, 2023, the training and onboarding of all 9 centers had been completed. Preliminary analyses will be conducted by the end of the second quarter of 2024, and results are expected to be publicly available by the middle of 2024. Conclusions: This study will provide the necessary data on HF, which will inform decisions on the prevention and management of HF and form the basis for future research. Trial Registration: ISRCTN Registry (United Kingdom) ISRCTN18216214; https:www.isrctn.com/ISRCTN18216214 International Registered Report Identifier (IRRID): DERR1-10.2196/52616 UR - https://www.researchprotocols.org/2024/1/e52616 UR - http://dx.doi.org/10.2196/52616 UR - http://www.ncbi.nlm.nih.gov/pubmed/38588528 ID - info:doi/10.2196/52616 ER - TY - JOUR AU - Deji, Zhuoga AU - Tong, Yuantao AU - Huang, Honglian AU - Zhang, Zeyu AU - Fang, Meng AU - Crabbe, C. M. James AU - Zhang, Xiaoyan AU - Wang, Ying PY - 2024/3/25 TI - Influence of Environmental Factors and Genome Diversity on Cumulative COVID-19 Cases in the Highland Region of China: Comparative Correlational Study JO - Interact J Med Res SP - e43585 VL - 13 KW - COVID-19 KW - environmental factors KW - altitude KW - population density KW - virus mutation N2 - 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 (?=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 (?=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. UR - https://www.i-jmr.org/2024/1/e43585 UR - http://dx.doi.org/10.2196/43585 UR - http://www.ncbi.nlm.nih.gov/pubmed/38526532 ID - info:doi/10.2196/43585 ER - TY - JOUR AU - Su, Shu AU - Jia, Meng AU - Yu, Yingni AU - Li, Hu AU - Yin, Wenwei AU - Lu, Yi AU - Huang, Rongzhong AU - Xiang, Rong AU - Huang, Huizhe AU - Hu, Peng PY - 2024/2/16 TI - Integrated Network Analysis of Symptom Clusters Across Monkeypox Epidemics From 1970 to 2023: Systematic Review and Meta-Analysis JO - JMIR Public Health Surveill SP - e49285 VL - 10 KW - monkeypox KW - mpox KW - symptoms KW - prevalence KW - meta-analysis KW - network analysis KW - evolution trends N2 - Background: The worldwide spread of monkeypox (mpox) has witnessed a significant increase, particularly in nonendemic countries. Objective: We aimed to investigate the changing clinical symptoms associated with mpox from 1970 to 2023 and explore their interrelations. Methods: In this systematic review and meta-analysis, 3 electronic databases were searched for English peer-reviewed studies conducted from January 1970 to April 2023 that reported any symptoms among confirmed mpox cases. We categorized the mpox epidemics into 3 periods: 1970-2002 (period 1, within the African region), 2003-2021(period 2, epidemics outside Africa), and 2022-2023 (period 3, worldwide outbreak). Following PRISMA guidelines, a meta-analysis was performed to estimate the pooled prevalence for each symptom. The correlation among symptoms was analyzed and visualized using network analysis. Results: The meta-analysis included 61 studies that reported 21 symptoms in 720 patients from period 1, 39 symptoms in 1756 patients from period 2, and 37 symptoms in 12,277 patients from period 3. The most common symptom among patients from all 3 periods was rash (period 1: 92.6%, 95% CI 78.2%-100%; period 2: 100%, 95% CI 99.9%-100%; and period 3: 94.8%, 95% CI 90.9%-98.8%), followed by lymphadenopathy (period 1: 59.8%, 95% CI 50.3%-69.2%; period 2: 74.1%, 95% CI 64.2%-84.1%; and period 3: 61.1%, 95% CI 54.2%-68.1%). Fever (99%, 95% CI 97%-100%), enlarged lymph nodes (80.5%, 95% CI 75.4%-85.0%), and headache (69.1%, 95% CI 4%-100%) were the main symptoms in period 1, with a significant decrease in period 3: 37.9%, 31.2%, and 28.7%, respectively. Chills/rigors (73.3%, 95% CI 60.9%-85.7%), fatigue (68.2%, 95% CI 51.6%-84.8%), and dysphagia/swallowing difficulty (61.2%, 95% CI 10.5%-100%) emerged as primary new symptoms in period 2 and decreased significantly in period 3. Most other symptoms remained unchanged or decreased in period 3 compared to the former 2 periods. Nausea/vomiting had the highest degree of correlation (with 13 symptoms) and was highly positively correlated with lymphadenopathy (r=0.908) and conjunctivitis (r=0.900) in period 2. In contrast, rash and headache were 2 symptoms with the highest degree of correlation (with 21 and 21 symptoms, respectively) in period 3 and were highly positively correlated with fever (r=0.918 and 0.789, respectively). Conclusions: The manifestation of symptoms in patients with mpox has become more diverse, leading to an increase in their correlation. Although the prevalence of rash remains steady, other symptoms have decreased. It is necessary to surveil the evolving nature of mpox and the consequential changes in clinical characteristics. Epidemic countries may shift their focus on the potential association among symptoms and the high synergy risk. Trial Registration: PROSPERO Registration: CRD42023403282; http://tinyurl.com/yruuas5n UR - https://publichealth.jmir.org/2024/1/e49285 UR - http://dx.doi.org/10.2196/49285 UR - http://www.ncbi.nlm.nih.gov/pubmed/38363593 ID - info:doi/10.2196/49285 ER - TY - JOUR AU - Pinheiro, Tavares Yago AU - Dantas, Costa Janmilli da AU - Holanda, Rodrigo Jose Rebberty AU - Feitosa, Andrade Ankilma do Nascimento AU - Augusto Rosendo da Silva, Richardson PY - 2024/1/4 TI - Epidemiology of Syphilis in Pregnancy and Congenital Syphilis in Brazil and the Risk or Associated Factors: Protocol for a Systematic Review JO - JMIR Res Protoc SP - e50702 VL - 13 KW - sexually transmitted diseases KW - epidemiology KW - prevalence KW - incidence KW - Brazil KW - syphilis KW - pregnancy KW - sociocultural KW - economic KW - congenital syphilis KW - heterogeneity KW - decision-making N2 - Background: Syphilis in pregnancy and congenital syphilis are growing public health issues worldwide. Several factors can influence their occurrence in the population. Therefore, understanding the epidemiology of this condition and the factors that influence its occurrence is fundamental for decision-making by clinicians and health managers. However, so far, no systematic review has summarized and analyzed data on the incidence, prevalence, and predictors of these diseases in Brazilian cities, considering different sociocultural, demographic, economic, sanitary, and spatial-temporal characteristics presented across locations. Objective: We propose a systematic review protocol to gather and analyze data on the incidence, prevalence, and risk or associated factors of syphilis in pregnancy and congenital syphilis in Brazil, taking into account different local or regional contexts. Methods: Searches will be conducted in CINAHL, MEDLINE, LILACS, Embase, and Web of Science databases. We will include observational studies (ie, cross-sectional, longitudinal, or case-control studies), analyzing the incidence, prevalence, and risk or associated factors of syphilis in pregnancy and congenital syphilis in Brazil from primary data. The diagnosed syphilis will be assessed based on direct pathogen detection tests or through immunological, treponemal or nontreponemal tests, following Brazilian protocols for diagnosing syphilis. The studies are currently undergoing screening in the databases, and after this step, 2 reviewers will perform all identified documents. The Newcastle-Ottawa Scale and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) system will be used to assess methodological quality and quality of evidence of studies, respectively. The Kappa coefficient will assess the agreement between researchers in each study stage. Cochran Q test will assess the heterogeneity among studies. Then, a random-effects meta-analysis will be performed. Results: Results will be discussed based on subgroup analysis, which is as follows: (1) type of syphilis (in pregnancy or congenital), (2) type of study (case-control and cross-sectional studies for analysis of associated factors and longitudinal studies for risk factors), and (3) contextual factors (ie, region of country, socioeconomic and demographic characteristics, and year of study). This systematic review is expected to be completed by December 2023, and our results will be disseminated through publication in peer-reviewed journals and scientific events. Conclusions: This systematic review aims to assist health care managers and professionals in their decision-making to control these diseases in Brazil, considering location heterogeneity. Furthermore, countries with health systems and demographic and socioeconomic contexts similar to those of Brazil may benefit from this information. International Registered Report Identifier (IRRID): DERR1-10.2196/50702 UR - https://www.researchprotocols.org/2024/1/e50702 UR - http://dx.doi.org/10.2196/50702 UR - http://www.ncbi.nlm.nih.gov/pubmed/38175689 ID - info:doi/10.2196/50702 ER - TY - JOUR AU - Herrera-Espejel, Sofia Paula AU - Rach, Stefan PY - 2023/11/20 TI - The Use of Machine Translation for Outreach and Health Communication in Epidemiology and Public Health: Scoping Review JO - JMIR Public Health Surveill SP - e50814 VL - 9 KW - machine translation KW - public health KW - epidemiology KW - population-based KW - recruitment KW - outreach KW - multilingual KW - culturally and linguistically diverse communities N2 - 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. UR - https://publichealth.jmir.org/2023/1/e50814 UR - http://dx.doi.org/10.2196/50814 UR - http://www.ncbi.nlm.nih.gov/pubmed/37983078 ID - info:doi/10.2196/50814 ER - TY - JOUR AU - Velez, Tom AU - Wang, Tony AU - Garibaldi, Brian AU - Singman, Eric AU - Koutroulis, Ioannis PY - 2023/10/6 TI - Identification and Prediction of Clinical Phenotypes in Hospitalized Patients With COVID-19: Machine Learning From Medical Records JO - JMIR Form Res SP - e46807 VL - 7 KW - big data KW - COVID KW - respiratory distress KW - critical care KW - early warning KW - electronic medical record KW - machine learning KW - clinical phenotypes KW - pathogenesis KW - infection KW - immune response KW - treatment KW - biomarkers KW - training KW - sepsis KW - mortality KW - utility KW - phenotype KW - support tool N2 - Background: There is significant heterogeneity in disease progression among hospitalized patients with COVID-19. The pathogenesis of SARS-CoV-2 infection is attributed to a complex interplay between virus and host immune response that in some patients unpredictably and rapidly leads to ?hyperinflammation? associated with increased risk of mortality. The early identification of patients at risk of progression to hyperinflammation may help inform timely therapeutic decisions and lead to improved outcomes. Objective: The primary objective of this study was to use machine learning to reproducibly identify specific risk-stratifying clinical phenotypes across hospitalized patients with COVID-19 and compare treatment response characteristics and outcomes. A secondary objective was to derive a predictive phenotype classification model using routinely available early encounter data that may be useful in informing optimal COVID-19 bedside clinical management. Methods: This was a retrospective analysis of electronic health record data of adult patients (N=4379) who were admitted to a Johns Hopkins Health System hospital for COVID-19 treatment from 2020 to 2021. Phenotypes were identified by clustering 38 routine clinical observations recorded during inpatient care. To examine the reproducibility and validity of the derived phenotypes, patient data were randomly divided into 2 cohorts, and clustering analysis was performed independently for each cohort. A predictive phenotype classifier using the gradient-boosting machine method was derived using routine clinical observations recorded during the first 6 hours following admission. Results: A total of 2 phenotypes (designated as phenotype 1 and phenotype 2) were identified in patients admitted for COVID-19 in both the training and validation cohorts with similar distributions of features, correlations with biomarkers, treatments, comorbidities, and outcomes. In both the training and validation cohorts, phenotype-2 patients were older; had elevated markers of inflammation; and were at an increased risk of requiring intensive care unit?level care, developing sepsis, and mortality compared with phenotype-1 patients. The gradient-boosting machine phenotype prediction model yielded an area under the curve of 0.89 and a positive predictive value of 0.83. Conclusions: Using machine learning clustering, we identified and internally validated 2 clinical COVID-19 phenotypes with distinct treatment or response characteristics consistent with similar 2-phenotype models derived from other hospitalized populations with COVID-19, supporting the reliability and generalizability of these findings. COVID-19 phenotypes can be accurately identified using machine learning models based on readily available early encounter clinical data. A phenotype prediction model based on early encounter data may be clinically useful for timely bedside risk stratification and treatment personalization. UR - https://formative.jmir.org/2023/1/e46807 UR - http://dx.doi.org/10.2196/46807 UR - http://www.ncbi.nlm.nih.gov/pubmed/37642512 ID - info:doi/10.2196/46807 ER - TY - JOUR AU - Li, Xiaopan AU - Liu, Ru AU - Chen, Yichen AU - Han, Yan AU - Wang, Qizhe AU - Xu, Yaxin AU - Zhou, Jing AU - Jiang, Sunfang PY - 2023/9/4 TI - Patterns and Trends in Mortality Associated With and Due to Diabetes Mellitus in a Transitioning Region With 3.17 Million People: Observational Study JO - JMIR Public Health Surveill SP - e43687 VL - 9 KW - diabetes mellitus KW - mortality KW - years of life lost KW - multimorbidity KW - trend analysis KW - diabetes KW - disease KW - urbanization KW - aging KW - epidemiology N2 - Background: Diabetes mellitus (DM) imposes a significant disease burden in economically transitioning regions. Most transitioning regions share similar experience in urbanization processes. Shanghai?s Pudong district serves as a representative area of such regions. Objective: We aimed to assess the burden of and trends in DM mortality in Shanghai?s Pudong district and analyze the impact of aging and multimorbidity. Methods: A longitudinal, population-based study was conducted to analyze DM mortality in Pudong from 2005 to 2020. We used joinpoint regression to analyze epidemiological features and long-term trends in crude mortality rate (CMR), age-standardized mortality rate worldwide (ASMRW), and years of life lost (YLL). Furthermore, the decomposition method was used to evaluate the contribution of demographic and nondemographic factors associated with mortality. Results: There were 49,414 deaths among individuals with DM, including 15,512 deaths due to DM. The CMR and ASMRW were 109.55/105 and 38.01/105 person-years, respectively. Among the mortality associated with and due to DM, the total annual ASMRW increased by 3.65% (95% CI 3.25%-4.06%) and 1.38% (95% CI 0.74%-2.02%), respectively. Additionally, the total annual YLL rate increased by 4.98% (95% CI 3.92%-6.05%) and 2.68% (95% CI 1.34%-4.04%). The rates of YLL increase in persons aged 30 to 44 years (3.98%, 95% CI 0.32%-7.78%) and 45 to 59 years (4.31%, 95% CI 2.95%-5.69%) were followed by the increase in persons aged 80 years and older (10.53%, 95% CI 9.45%-11.62%) for deaths associated with DM. The annual CMR attributable to demographic factors increased by 41.9% (95% CI 17.73%-71.04%) and 36.72% (95% CI 16.69%-60.2%) for deaths associated with and due to DM, respectively. Hypertension, cerebrovascular disease, and ischemic heart disease were the top 3 comorbidities. Conclusions: Aging and multimorbidity played essential roles in changing the burden of DM in an urbanizing and transitioning region. There is an increasing disease burden among young and middle-aged people, emphasizing the need for greater attention to these groups. Health management is an emerging method that holds important implications for alleviating the future burden of DM. UR - https://publichealth.jmir.org/2023/1/e43687 UR - http://dx.doi.org/10.2196/43687 UR - http://www.ncbi.nlm.nih.gov/pubmed/37665630 ID - info:doi/10.2196/43687 ER - TY - JOUR AU - Yano, Rina AU - Terada-Hirashima, Junko AU - Uemura, Yukari AU - Tomita, Noriko AU - Shimizu, Yosuke AU - Iwasaki, Haruka AU - Okumura, Nobumasa AU - Suzuki, Tetsuya AU - Saito, Sho AU - Ujiie, Mugen AU - Sugiura, Wataru AU - Ohmagari, Norio PY - 2023/8/25 TI - Efficacy and Safety of the Smallpox Vaccine for Postexposure Prophylaxis in Monkeypox: Protocol for an Open-Labeled, Single-Armed Study JO - JMIR Res Protoc SP - e46955 VL - 12 KW - monkeypox KW - post-exposure prophylaxis KW - smallpox vaccine KW - vaccinia virus KW - LC16 KW - poxvirus KW - smallpox KW - vaccination KW - smallpox virus KW - orthopoxvirus KW - immunity KW - epidemiology KW - zoonosis KW - virus KW - vaccine KW - Disease Control and Prevention KW - inoculation KW - injection site KW - body temperature KW - headache KW - rash KW - lymphadenopathy KW - infectious disease KW - endpoint analysis N2 - Background: In May 2022, a case of monkeypox (currently known as ?mpox?) with no history of overseas travel was reported in the United Kingdom, followed by reports of infections reported in Europe, the United States, and other countries worldwide. Due to the significant overlap in immune responses among viruses of the genus Orthopoxvirus (including smallpox virus, mpox virus, and vaccinia virus), it is believed that cross-immunity can be achieved by administering the smallpox virus vaccine. In Japan, a smallpox vaccine (LC16m8 strain vaccine) has been approved; however, there was no regulatory approval for the mpox vaccine during the design of this study. Although it is believed that individuals exposed to the mpox virus may receive smallpox vaccination as mpox prophylaxis, the existing evidence is not clear. Objective: The primary objective was to evaluate the efficacy of the LC16m8 strain vaccine, approved for smallpox in Japan, for postexposure prophylaxis against mpox when administered to close contacts of individuals with mpox. The secondary objective was to investigate the safety of the vaccine for postexposure prophylaxis against mpox. Methods: The study aimed to enroll 100 vaccinated participants who had been identified as close contacts of individuals with mpox. Consent was obtained, and the participants are inoculated with the vaccine. Daily recordings of symptoms (body temperature, headache, rash, and side effects) were made until day 21 and then again on day 28. Furthermore, additional evaluations of adverse events were performed by the investigators on days 7, 14, 21, and 28. Considering that the maximum incubation period for mpox is 21 days, the primary end point is the presence or absence of the disease 21 days after close contact. The primary analysis focused on cases within 4 days of intense contact as it has been reported that vaccination within this timeframe can reduce the incidence of the disease. Results: The first trial participant was enrolled on July 28, 2022, and the research period concluded in March 2023. The study results will be published in a peer-reviewed scientific journal. Conclusions: This study allowed us to investigate the efficacy and safety of the LC16m8 strain vaccine in postexposure prophylaxis against mpox. Trial Registration: Japan Registry of Clinical Trials jRCTs031220137; https://jrct.niph.go.jp/en-latest-detail/jRCTs031220137 International Registered Report Identifier (IRRID): DERR1-10.2196/46955 UR - https://www.researchprotocols.org/2023/1/e46955 UR - http://dx.doi.org/10.2196/46955 UR - http://www.ncbi.nlm.nih.gov/pubmed/37624623 ID - info:doi/10.2196/46955 ER - TY - JOUR AU - Adah, Ruth AU - Yusufu, Hope AU - Otene, Vivian Queen-Amina PY - 2023/7/12 TI - Epidemiology and Perception of Acne Among Adolescents in Jos, Nigeria: Cross-Sectional School-Based Study JO - JMIR Dermatol SP - e44441 VL - 6 KW - prevalence KW - predictors KW - misconception KW - perception KW - groundnuts KW - pimples KW - teenagers KW - acne KW - dermatology KW - Nigeria KW - acne vulgaris KW - comedone KW - papule KW - pustule KW - nodule KW - cyst KW - blackhead KW - whitehead N2 - Background: Adolescents who make up a vast majority of the secondary school population are at a stage at which they are largely affected by acne. This condition, which is widely visible and easily recognized by peers, has numerous misperceptions surrounding it, which may influence attitudes toward people affected by it. There is a paucity of information on the prevalence of acne and how adolescents in Jos, Nigeria, view the condition. Objective: This study aimed to determine the prevalence of acne, perceived risk factors, and the accuracy of self-report among adolescents in Jos, Nigeria. The study also sought to understand perceptions surrounding acne in this age group. Methods: This descriptive cross-sectional study was conducted among adolescents attending private and public secondary schools in Jos, Nigeria. In total, 482 students were recruited through a multistaged stratified random sampling method. A self-administered semistructured questionnaire was used to collect information on history of acne, perceptions of causes, and the attitude toward those who have the condition. All participants were examined for the presence of acne. Univariate, bivariate, and multivariate analysis were conducted using SPSS (version 26; IBM Corp). Results: The self-reported prevalence of acne was 44% and that upon clinical examination was 55%. Self-report showed a moderate degree of agreement with clinical diagnosis (Cohen ?=57.3%; P<.001). Predictive factors for the presence of acne in general were age of ?15 years (odds ratio [OR] 1.79, 95% CI 1.12-2.87; P=.02), being in a private school (OR 2.17, 95% CI 1.38-3.42; P=.001), and being in a senior secondary class (OR 2.14, 95% CI 1.32-3.47; P=.002). The female gender (OR 3.03, 95% CI 1.64-5.61; P=.001) and religion (OR 3.24, 95% CI 1.27-8.24; P=.02) were predictive for acne only among adolescents aged <15 years, while a positive family history was predictive in those aged ?15 years (OR 2.04, 95% CI 1.15-3.61; P=.02). A distinct perception and attitude pattern surrounding acne was observed, as a significant proportion (84/131, 64.1% vs 47/131, 35.9%; P=.02) of those who related acne to a biological phenomenon had acne themselves; however, the belief that acne is caused by skin lightening practices was significantly more common in those without acne (19/28, 67.9%) than in those with acne (9/28, 32.1%; P=.01). One-fourth of the adolescents (n=122, 25.3%) had no idea of the possible causes of acne. Conclusions: Though acne is a prevalent skin condition among Nigerian adolescents, many misperceptions and unfavorable attitudes surround acne and persons affected by the condition. Our findings have revealed the need to work with the school health program to educate the general adolescent population about acne, to refer and manage teenagers with acne. UR - https://derma.jmir.org/2023/1/e44441 UR - http://dx.doi.org/10.2196/44441 UR - http://www.ncbi.nlm.nih.gov/pubmed/37632928 ID - info:doi/10.2196/44441 ER - TY - JOUR AU - Singh, Ashima AU - Sontag, K. Marci AU - Zhou, Mei AU - Dasgupta, Mahua AU - Crume, Tessa AU - McLemore, Morgan AU - Galadanci, Najibah AU - Randall, Eldrida AU - Steiner, Nicole AU - Brandow, M. Amanda AU - Koch, Kathryn AU - Field, J. Joshua AU - Hassell, Kathryn AU - Snyder, B. Angela AU - Kanter, Julie PY - 2023/6/28 TI - Evaluating the Discriminatory Ability of the Sickle Cell Data Collection Program?s Administrative Claims Case Definition in Identifying Adults With Sickle Cell Disease: Validation Study JO - JMIR Public Health Surveill SP - e42816 VL - 9 KW - surveillance using administrative data KW - rare conditions KW - sickle cell disease KW - disease KW - surveillance KW - genetic KW - prevention KW - data KW - adults KW - epidemiology KW - utilization N2 - Background: Sickle cell disease (SCD) was first recognized in 1910 and identified as a genetic condition in 1949. However, there is not a universal clinical registry that can be used currently to estimate its prevalence. The Sickle Cell Data Collection (SCDC) program, funded by the Centers for Disease Control and Prevention, funds state-level grantees to compile data within their states from various sources including administrative claims to identify individuals with SCD. The performance of the SCDC administrative claims case definition has been validated in a pediatric population with SCD, but it has not been tested in adults. Objective: The objective of our study is to evaluate the discriminatory ability of the SCDC administrative claims case definition to accurately identify adults with SCD using Medicaid insurance claims data. Methods: Our study used Medicaid claims data in combination with hospital-based medical record data from the Alabama, Georgia, and Wisconsin SCDC programs to identify individuals aged 18 years or older meeting the SCDC administrative claims case definition. In order to validate this definition, our study included only those individuals who were identified in both Medicaid?s and the partnering clinical institution?s records. We used clinical laboratory tests and diagnostic algorithms to determine the true SCD status of this subset of patients. Positive predictive values (PPV) are reported overall and by state under several scenarios. Results: There were 1219 individuals (354 from Alabama and 865 from Georgia) who were identified through a 5-year time period. The 5-year time period yielded a PPV of 88.4% (91% for data from Alabama and 87% for data from Georgia), when only using data with laboratory-confirmed (gold standard) cases as true positives. With a narrower time period (3-year period) and data from 3 states (Alabama, Georgia, and Wisconsin), a total of 1432 individuals from these states were included in our study. The overall 3-year PPV was 89.4% (92%, 93%, and 81% for data from Alabama, Georgia, and Wisconsin, respectively) when only considering laboratory-confirmed cases as true cases. Conclusions: Adults identified as having SCD from administrative claims data based on the SCDC case definition have a high probability of truly having the disease, especially if those hospitals have active SCD programs. Administrative claims are thus a valuable data source to identify adults with SCD in a state and understand their epidemiology and health care service usage. UR - https://publichealth.jmir.org/2023/1/e42816 UR - http://dx.doi.org/10.2196/42816 UR - http://www.ncbi.nlm.nih.gov/pubmed/37379070 ID - info:doi/10.2196/42816 ER - TY - JOUR AU - Nisa, Shahista AU - Vallee, Emilie AU - Marshall, Jonathan AU - Collins-Emerson, Julie AU - Yeung, Polly AU - Prinsen, Gerard AU - Douwes, Jeroen AU - Baker, G. Michael AU - Wright, Jackie AU - Quin, Tanya AU - Holdaway, Maureen AU - Wilkinson, A. David AU - Fayaz, Ahmed AU - Littlejohn, Stuart AU - Benschop, Jackie PY - 2023/6/8 TI - Leptospirosis in Aotearoa New Zealand: Protocol for a Nationwide Case-Control Study JO - JMIR Res Protoc SP - e47900 VL - 12 KW - leptospirosis KW - Leptospira KW - case-control study KW - New Zealand KW - mixed methods KW - protocol KW - Indigenous health KW - public health KW - One Health N2 - 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 UR - https://www.researchprotocols.org/2023/1/e47900 UR - http://dx.doi.org/10.2196/47900 UR - http://www.ncbi.nlm.nih.gov/pubmed/37289491 ID - info:doi/10.2196/47900 ER - TY - JOUR AU - Addis Gesese, Abreha AU - Duer Thot, Tut PY - 2023/5/22 TI - Face Mask Use and Associated Factors Among Students: Mixed Methods Study JO - Interact J Med Res SP - e41365 VL - 12 KW - face mask use KW - associated factors KW - COVID-19 KW - Gambella KW - students KW - Ethiopia N2 - 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. UR - https://www.i-jmr.org/2023/1/e41365 UR - http://dx.doi.org/10.2196/41365 UR - http://www.ncbi.nlm.nih.gov/pubmed/37130014 ID - info:doi/10.2196/41365 ER - TY - JOUR AU - Ab Kadir, Akram Muhammad AU - Abdul Manaf, Rosliza AU - Mokhtar, Aisah Siti AU - Ismail, Idzhar Luthffi PY - 2023/5/15 TI - Spatio-Temporal Analysis of Leptospirosis Hotspot Areas and Its Association With Hydroclimatic Factors in Selangor, Malaysia: Protocol for an Ecological Cross-sectional Study JO - JMIR Res Protoc SP - e43712 VL - 12 KW - leptospirosis KW - hotspot areas KW - hydroclimatic factors KW - Selangor KW - geographical information system KW - GIS KW - predictive model N2 - 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 UR - https://www.researchprotocols.org/2023/1/e43712 UR - http://dx.doi.org/10.2196/43712 UR - http://www.ncbi.nlm.nih.gov/pubmed/37184897 ID - info:doi/10.2196/43712 ER - TY - JOUR AU - Lu, Zhen AU - Fu, Leiwen AU - Yang, Luoyao AU - Tian, Tian AU - Gao, Yanxiao AU - Meng, Xiaojun AU - Zou, Huachun PY - 2023/5/1 TI - Hesitancy to Undergo SARS-CoV-2 Rapid Antigen Testing in China: Nationwide Cross-sectional Study JO - JMIR Public Health Surveill SP - e43555 VL - 9 KW - COVID-19 KW - SARS-CoV-2 KW - vaccine KW - hesitancy KW - rapid antigen testing KW - China N2 - Background: SARS-CoV-2 rapid antigen testing (RAT) could be a useful supplementary test to diagnose larger numbers of acute asymptomatic infections and alleviate the limitations of polymerase chain reaction testing. However, hesitancy to undergo SARS-CoV-2 RAT may compromise its implementation. Objective: We aimed to understand the prevalence and correlates of hesitancy to undergo RAT among adults not infected with SARS-CoV-2 in mainland China. Methods: A nationwide cross-sectional survey on hesitancy to undergo SARS-CoV-2 RAT was conducted among adults not infected with SARS-CoV-2 in mainland China between April 29, 2022, and May 10, 2022. Participants completed an online questionnaire that covered the following COVID-19?related factors: sociodemographic characteristics, experiences of COVID-19 restrictions and knowledge of COVID-19, and attitude toward COVID-19 and its screening. This study was a secondary analysis of data from the survey. We compared the characteristics of participants by hesitancy to undergo SARS-CoV-2 RAT. Thereafter, logistic regression with a sparse group minimax concave penalty was used to identify correlates of hesitancy to undergo RAT. Results: We recruited 8856 individuals with diverse demographic, socioeconomic, and geographic characteristics in China. Eventually, 5388 participants (valid response rate of 60.84%; 52.32% [2819/5388] women; median age 32 years) were included in the analysis. Among the 5388 participants, 687 (12.75%) expressed hesitancy to undergo RAT and 4701 (87.25%) were willing to undergo RAT. Notably, those who were from the central region (adjusted odds ratio [aOR] 1.815, 95% CI 1.441-2.278) and those who received COVID-19 information from traditional media (aOR 1.544, 95% CI 1.279-1.863) were significantly more likely to report hesitancy to undergo RAT (both P<.001). However, those who were women (aOR 0.720, 95% CI 0.599-0.864), were older (aOR 0.982, 95% CI 0.969-0.995), had postgraduate education (aOR 0.612, 95% CI 0.435-0.858), had children (<6 years old) and elders (>60 years old) in the family (aOR 0.685, 95% CI 0.510-0.911), had better knowledge about COVID-19 (aOR 0.942, 95% CI 0.916-0.970), and had mental health disorders (aOR 0.795, 95% CI 0.646-0.975) were less likely to report hesitancy to undergo RAT. Conclusions: Hesitancy to undergo SARS-CoV-2 RAT was low among individuals who were not yet infected with SARS-CoV-2. Efforts should be made to improve the awareness and acceptance of RAT among men, younger adults, individuals with a lower education or salary, families without children and elders, and individuals who access COVID-19 information via traditional media. In a reopening world, our study could inform the development of contextualized mass screening strategies in general and the scale-up of RAT in particular, which remains an indispensable option in emergency preparedness. UR - https://publichealth.jmir.org/2023/1/e43555 UR - http://dx.doi.org/10.2196/43555 UR - http://www.ncbi.nlm.nih.gov/pubmed/36888911 ID - info:doi/10.2196/43555 ER - TY - JOUR AU - Zheng, Junyao AU - Zhang, Ning AU - Shen, Guoquan AU - Liang, Fengchao AU - Zhao, Yang AU - He, Xiaochen AU - Wang, Ying AU - He, Rongxin AU - Chen, Wenna AU - Xue, Hao AU - Shen, Yue AU - Fu, Yang AU - Zhang, Wei-Hong AU - Zhang, Lei AU - Bhatt, Samir AU - Mao, Ying AU - Zhu, Bin PY - 2023/4/27 TI - Spatiotemporal and Seasonal Trends of Class A and B Notifiable Infectious Diseases in China: Retrospective Analysis JO - JMIR Public Health Surveill SP - e42820 VL - 9 KW - notifiable infectious diseases KW - spatial epidemiology KW - temporal trends KW - seasonal feature KW - spatial disparities N2 - Background: China is the most populous country globally and has made significant achievements in the control of infectious diseases over the last decades. The 2003 SARS epidemic triggered the initiation of the China Information System for Disease Control and Prevention (CISDCP). Since then, numerous studies have investigated the epidemiological features and trends of individual infectious diseases in China; however, few considered the changing spatiotemporal trends and seasonality of these infectious diseases over time. Objective: This study aims to systematically review the spatiotemporal trends and seasonal characteristics of class A and class B notifiable infectious diseases in China during 2005-2020. Methods: We extracted the incidence and mortality data of 8 types (27 diseases) of notifiable infectious diseases from the CISDCP. We used the Mann-Kendall and Sen?s methods to investigate the diseases? temporal trends, Moran I statistic for their geographical distribution, and circular distribution analysis for their seasonality. Results: Between January 2005 and December 2020, 51,028,733 incident cases and 261,851 attributable deaths were recorded. Pertussis (P=.03), dengue fever (P=.01), brucellosis (P=.001), scarlet fever (P=.02), AIDS (P<.001), syphilis (P<.001), hepatitis C (P<.001) and hepatitis E (P=.04) exhibited significant upward trends. Furthermore, measles (P<.001), bacillary and amebic dysentery (P<.001), malaria (P=.04), dengue fever (P=.006), brucellosis (P=.03), and tuberculosis (P=.003) exhibited significant seasonal patterns. We observed marked disease burden?related geographic disparities and heterogeneities. Notably, high-risk areas for various infectious diseases have remained relatively unchanged since 2005. In particular, hemorrhagic fever and brucellosis were largely concentrated in Northeast China; neonatal tetanus, typhoid and paratyphoid, Japanese encephalitis, leptospirosis, and AIDS in Southwest China; BAD in North China; schistosomiasis in Central China; anthrax, tuberculosis, and hepatitis A in Northwest China; rabies in South China; and gonorrhea in East China. However, the geographical distribution of syphilis, scarlet fever, and hepatitis E drifted from coastal to inland provinces during 2005-2020. Conclusions: The overall infectious disease burden in China is declining; however, hepatitis C and E, bacterial infections, and sexually transmitted infections continue to multiply, many of which have spread from coastal to inland provinces UR - https://publichealth.jmir.org/2023/1/e42820 UR - http://dx.doi.org/10.2196/42820 UR - http://www.ncbi.nlm.nih.gov/pubmed/37103994 ID - info:doi/10.2196/42820 ER - TY - JOUR AU - Zhang, Qi AU - Ding, Huan AU - Gao, Song AU - Zhang, Shipeng AU - Shen, Shiya AU - Chen, Xiaoyan AU - Xu, Zhuping PY - 2023/3/8 TI - Spatiotemporal Changes in Pulmonary Tuberculosis Incidence in a Low-Epidemic Area of China in 2005-2020: Retrospective Spatiotemporal Analysis JO - JMIR Public Health Surveill SP - e42425 VL - 9 KW - pulmonary tuberculosis KW - spatial analysis KW - temporal analysis KW - epidemiology KW - China N2 - Background: In China, tuberculosis (TB) is still a major public health problem, and the incidence of TB has significant spatial heterogeneity. Objective: This study aimed to investigate the temporal trends and spatial patterns of pulmonary tuberculosis (PTB) in a low-epidemic area of eastern China, Wuxi city, from 2005 to 2020. Methods: The data of PTB cases from 2005 to 2020 were obtained from the Tuberculosis Information Management System. The joinpoint regression model was used to identify the changes in the secular temporal trend. Kernel density analysis and hot spot analysis were used to explore the spatial distribution characteristics and clusters of the PTB incidence rate. Results: A total of 37,592 cases were registered during 2005-2020, with an average annual incidence rate of 34.6 per 100,000 population. The population older than 60 years had the highest incidence rate of 59.0 per 100,000 population. In the study period, the incidence rate decreased from 50.4 to 23.9 per 100,000 population, with an average annual percent change of ?4.9% (95% CI ?6.8% to ?2.9%). The incidence rate of pathogen-positive patients increased during 2017-2020, with an annual percent change of 13.4% (95% CI 4.3%-23.2%). The TB cases were mainly concentrated in the city center, and the incidence of hot spots areas gradually changed from rural areas to urban areas during the study period. Conclusions: The PTB incidence rate in Wuxi city has been declining rapidly with the effective implementation of strategies and projects. The populated urban centers will become key areas of TB prevention and control, especially in the older population. UR - https://publichealth.jmir.org/2023/1/e42425 UR - http://dx.doi.org/10.2196/42425 UR - http://www.ncbi.nlm.nih.gov/pubmed/36884278 ID - info:doi/10.2196/42425 ER - TY - JOUR AU - Obase, Ngemani Bekindaka AU - Francis, Zeukeng AU - Forgu, Livo Esemu AU - Honore, Awanakam AU - Bigoga, Daiga Jude AU - Nsagha, S. Dickson PY - 2023/1/24 TI - The Effects of HIV Infection on the Immune Response to Malaria Among Pregnant Women in Kumba, Southwest Cameroon: Protocol for a Cross-sectional Study JO - JMIR Res Protoc SP - e38213 VL - 12 KW - malaria KW - HIV KW - co-infection KW - pregnancy KW - prevalence KW - allele KW - immunity KW - antibodies KW - cytokines KW - Cameroon N2 - Background: Malaria and HIV, 2 of the world's deadliest diseases, share a lot of territory in sub-Saharan Africa. Objective: This study seeks to investigate the effect of HIV on the immune response to malaria infection among pregnant women in Kumba in the southwest region (SWR) of Cameroon. The study aims to determine the prevalence of malaria infection, assess the occurrence of Plasmodium falciparum genetic diversity, and evaluate the antibody (immunoglobulin [Ig]G and IgM: apical membrane antigen-1 [AMA1], merozoite surface protein [MSP]1, MSP2, MSP3, and erythrocyte-binding antigen [EBA]175) and cytokine (interleukin [IL]-10, tumor necrosis factor alpha [TNF-?], and interferon gamma [IFN?]) response to malaria infection among pregnant women with and without HIV in Kumba. Methods: The study will be a hospital-based cross-sectional design that will run from March 2022 to February 2023. It will recruit pregnant women with and without HIV who are in their third trimester of pregnancy. The study will be carried out in 5 health institutions in Kumba: General Hospital Kumba, Presbyterian Hospital Kumba, District Hospital Kumba-town, Kossala Integrated Health Center Kumba, and Catholic Hospital Kumba. About 3 mL of the mother?s venous blood, placental blood, and baby cord blood will be collected from each pregnant women at the point of delivery. Microscopy, rapid diagnostic tests (RDTs), and nested polymerase chain reaction (PCR) will be performed to identify the malaria parasite in all the samples, and nested PCR targeting the different genetic diversity markers for P. falciparum will also be performed. Furthermore, sequencing will be performed to study the nucleotide sequence of different alleles, and the genetic diversity of the alleles responsible for malaria infection among pregnant women will be assessed. A multiplex assay will be conducted to analyze the peripheral blood plasma and cord blood plasma for the cytokine and total antibody response to malaria infection among pregnant women with and without HIV. The questionnaire for data collection will be pretested at the Kumba District Hospital, and ethical clearance will be obtained from the University of Buea and the Regional Delegation of Public Health for the SWR. Data will be analyzed using SPSS Statistics and STATA. All P values <.05 will be considered statistically significant. BioEdit 7.0.0 software will be used to align the nucleotide sequences of different genes after sequencing. Phylogenetic tree searching will be conducted using the maximum-likelihood (ML) method in MEGA V6.0. Results: The project started in March 2022 and will end in February 2023. Presently, three-fourth of the project funding has been disbursed to date. A total of 218 participants have been enrolled: 193 (88.5%) women without HIV and 25 (11.5%) women with HIV. Between February 2023 and March 2024, the following results will be ready for publication: maternal-neonatal malaria prevalence among pregnant women and babies in Kumba, the effect of HIV on (1) P. falciparum genetic diversity among pregnant women in Kumba, (2) the maternal and neonatal immune response to MSP1, MSP2, and EBA175 IgG antibody response to P. falciparum?caused malaria infection among pregnant women, and (3) the maternal and neonatal pro-inflammatory and anti-inflammatory cytokine response to malaria infection. Conclusions: HIV infection increases the prevalence of malaria infection among pregnant women and also influences the genetic diversity of P. falciparum, with MSP1 alleles being the most prevalent. HIV infection also reduces the antibody response to malaria infection, as well as altering the level of pro-inflammatory and anti-inflammatory responses to malaria infection. International Registered Report Identifier (IRRID): DERR1-10.2196/38213 UR - https://www.researchprotocols.org/2023/1/e38213 UR - http://dx.doi.org/10.2196/38213 UR - http://www.ncbi.nlm.nih.gov/pubmed/36692923 ID - info:doi/10.2196/38213 ER - TY - JOUR AU - Karystianis, George AU - Lukmanjaya, Wilson AU - Simpson, Paul AU - Schofield, Peter AU - Ginnivan, Natasha AU - Nenadic, Goran AU - van Leeuwen, Marina AU - Buchan, Iain AU - Butler, Tony PY - 2022/12/5 TI - An Analysis of PubMed Abstracts From 1946 to 2021 to Identify Organizational Affiliations in Epidemiological Criminology: Descriptive Study JO - Interact J Med Res SP - e42891 VL - 11 IS - 2 KW - epidemiological criminology KW - PubMed KW - offenders KW - justice health KW - affiliations KW - health database KW - research output KW - criminology KW - publication KW - open research KW - research promotion KW - epidemiology research KW - research database N2 - Background: Epidemiological criminology refers to health issues affecting incarcerated and nonincarcerated offender populations, a group recognized as being challenging to conduct research with. Notwithstanding this, an urgent need exists for new knowledge and interventions to improve health, justice, and social outcomes for this marginalized population. Objective: To better understand research outputs in the field of epidemiological criminology, we examined the lead author?s affiliation by analyzing peer-reviewed published outputs to determine countries and organizations (eg, universities, governmental and nongovernmental organizations) responsible for peer-reviewed publications. Methods: We used a semiautomated approach to examine the first-author affiliations of 23,904 PubMed epidemiological studies related to incarcerated and offender populations published in English between 1946 and 2021. We also mapped research outputs to the World Justice Project Rule of Law Index to better understand whether there was a relationship between research outputs and the overall standard of a country?s justice system. Results: Nordic countries (Sweden, Norway, Finland, and Denmark) had the highest research outputs proportional to their incarcerated population, followed by Australia. University-affiliated first authors comprised 73.3% of published articles, with the Karolinska Institute (Sweden) being the most published, followed by the University of New South Wales (Australia). Government-affiliated first authors were on 8.9% of published outputs, and prison-affiliated groups were on 1%. Countries with the lowest research outputs also had the lowest scores on the Rule of Law Index. Conclusions: This study provides important information on who is publishing research in the epidemiological criminology field. This has implications for promoting research diversity, independence, funding equity, and partnerships between universities and government departments that control access to incarcerated and offending populations. UR - https://www.i-jmr.org/2022/2/e42891 UR - http://dx.doi.org/10.2196/42891 UR - http://www.ncbi.nlm.nih.gov/pubmed/36469411 ID - info:doi/10.2196/42891 ER - TY - JOUR AU - McNeil, Carrie AU - Verlander, Sarah AU - Divi, Nomita AU - Smolinski, Mark PY - 2022/8/5 TI - The Landscape of Participatory Surveillance Systems Across the One Health Spectrum: Systematic Review JO - JMIR Public Health Surveill SP - e38551 VL - 8 IS - 8 KW - participatory surveillance KW - One Health KW - citizen science KW - community-based surveillance KW - infectious disease KW - digital disease detection KW - community participation KW - mobile phone N2 - Background: Participatory surveillance systems augment traditional surveillance systems through bidirectional community engagement. The digital platform evolution has enabled the expansion of participatory surveillance systems, globally, for the detection of health events impacting people, animals, plants, and the environment, in other words, across the entire One Health spectrum. Objective: The aim of this landscape was to identify and provide descriptive information regarding system focus, geography, users, technology, information shared, and perceived impact of ongoing participatory surveillance systems across the One Health spectrum. Methods: This landscape began with a systematic literature review to identify potential ongoing participatory surveillance systems. A survey was sent to collect standardized data from the contacts of systems identified in the literature review and through direct outreach to stakeholders, experts, and professional organizations. Descriptive analyses of survey and literature review results were conducted across the programs. Results: The landscape identified 60 ongoing single-sector and multisector participatory surveillance systems spanning five continents. Of these, 29 (48%) include data on human health, 26 (43%) include data on environmental health, and 24 (40%) include data on animal health. In total, 16 (27%) systems are multisectoral; of these, 9 (56%) collect animal and environmental health data; 3 (19%) collect human, animal, and environmental health data; 2 (13%) collect human and environmental health data; and 2 (13%) collect human and animal health data. Out of 60 systems, 31 (52%) are designed to cover a national scale, compared to those with a subnational (n=19, 32%) or multinational (n=10, 17%) focus. All systems use some form of digital technology. Email communication or websites (n=40, 67%) and smartphones (n=29, 48%) are the most common technologies used, with some using both. Systems have capabilities to download geolocation data (n=31, 52%), photographs (n=29, 48%), and videos (n=6, 10%), and can incorporate lab data or sample collection (n=15, 25%). In sharing information back with users, most use visualization, such as maps (n=43, 72%); training and educational materials (n=37, 62%); newsletters, blogs, and emails (n=34, 57%); and disease prevention information (n=32, 53%). Out of the 46 systems responding to the survey regarding perceived impacts of their systems, 36 (78%) noted ?improved community knowledge and understanding? and 31 (67%) noted ?earlier detection.? Conclusions: The landscape demonstrated the breadth of applicability of participatory surveillance around the world to collect data from community members and trained volunteers in order to inform the detection of events, from invasive plant pests to weekly influenza symptoms. Acknowledging the importance of bidirectionality of information, these systems simultaneously share findings back with the users. Such directly engaged community detection systems capture events early and provide opportunities to stop outbreaks quickly. UR - https://publichealth.jmir.org/2022/8/e38551 UR - http://dx.doi.org/10.2196/38551 UR - http://www.ncbi.nlm.nih.gov/pubmed/35930345 ID - info:doi/10.2196/38551 ER - TY - JOUR AU - Fu, Leiwen AU - Tian, Tian AU - Yao, Kai AU - Chen, Xiang-Feng AU - Luo, Ganfeng AU - Gao, Yanxiao AU - Lin, Yi-Fan AU - Wang, Bingyi AU - Sun, Yinghui AU - Zheng, Weiran AU - Li, Peiyang AU - Zhan, Yuewei AU - Fairley, K. Christopher AU - Grulich, Andrew AU - Zou, Huachun PY - 2022/7/6 TI - Global Pattern and Trends in Penile Cancer Incidence: Population-Based Study JO - JMIR Public Health Surveill SP - e34874 VL - 8 IS - 7 KW - global burden KW - penile cancer KW - incidence KW - average annual percentage change KW - epidemiology N2 - Background: Penile cancer is a relatively rare genital malignancy whose incidence and mortality are rising in many countries. Objective: This study aims to assess the recent incidence and mortality patterns and incidence trends of penile cancer. Methods: The age-standardized incidence and mortality rates (ASIR and ASMR, respectively) of penile cancer in 2020 were estimated from the Global Cancer Registries (GLOBOCAN) database. Incidence trends of penile cancer from 1973 to 2012 were assessed in 44 populations from 43 countries using the Cancer Incidence in Five Continents plus (CI5plus) and the Nordic Cancer Registries (NORDCAN) databases. Average annual percentage change was calculated to quantify trends in ASIR using joinpoint regression. Results: Globally, the estimated ASIR and ASMR of penile cancer were 0.80 (per 100,000) and 0.29 (per 100,000) in 2020, equating to 36,068 new cases and 13,211 deaths in 2020, respectively. There was no significant correlation between the ASIR (P=.05) or ASMR (P=.90) and Human Development Index. In addition, 15 countries saw increasing ASIR for penile cancer, 13 of which were from Europe (United Kingdom, Lithuania, Norway, Estonia, Finland, Sweden, Cyprus, Netherlands, Italy, Croatia, Slovakia, Russia, and the Czech), and 2 from Asia (China and Israel). Conclusions: Although the developing countries still bear the higher incidence and mortality of penile cancer, the incidence is on the rise in most European countries. To mitigate the disease burden resulting from penile cancer, measures to lower the risk for penile cancers, including improving penile hygiene and male human papillomavirus vaccination, may be warranted. UR - https://publichealth.jmir.org/2022/7/e34874 UR - http://dx.doi.org/10.2196/34874 UR - http://www.ncbi.nlm.nih.gov/pubmed/35793140 ID - info:doi/10.2196/34874 ER - TY - JOUR AU - Zhao, Xixi AU - Li, Meijia AU - Haihambo, Naem AU - Jin, Jianhua AU - Zeng, Yimeng AU - Qiu, Jinyi AU - Guo, Mingrou AU - Zhu, Yuyao AU - Li, Zhirui AU - Liu, Jiaxin AU - Teng, Jiayi AU - Li, Sixiao AU - Zhao, Ya-nan AU - Cao, Yanxiang AU - Wang, Xuemei AU - Li, Yaqiong AU - Gao, Michel AU - Feng, Xiaoyang AU - Han, Chuanliang PY - 2022/6/23 TI - Changes in Temporal Properties of Notifiable Infectious Disease Epidemics in China During the COVID-19 Pandemic: Population-Based Surveillance Study JO - JMIR Public Health Surveill SP - e35343 VL - 8 IS - 6 KW - class B infectious disease KW - COVID-19 KW - event-related trough KW - infection selectivity KW - oscillation KW - public health interventions KW - pandemic KW - surveillance KW - health policy KW - epidemiology KW - prevention policy KW - public health KW - risk prevention N2 - Background: COVID-19 was first reported in 2019, and the Chinese government immediately carried out stringent and effective control measures in response to the epidemic. Objective: Nonpharmaceutical interventions (NPIs) may have impacted incidences of other infectious diseases as well. Potential explanations underlying this reduction, however, are not clear. Hence, in this study, we aim to study the influence of the COVID-19 prevention policies on other infectious diseases (mainly class B infectious diseases) in China. Methods: Time series data sets between 2017 and 2021 for 23 notifiable infectious diseases were extracted from public data sets from the National Health Commission of the People?s Republic of China. Several indices (peak and trough amplitudes, infection selectivity, preferred time to outbreak, oscillatory strength) of each infectious disease were calculated before and after the COVID-19 outbreak. Results: We found that the prevention and control policies for COVID-19 had a strong, significant reduction effect on outbreaks of other infectious diseases. A clear event-related trough (ERT) was observed after the outbreak of COVID-19 under the strict control policies, and its decreasing amplitude is related to the infection selectivity and preferred outbreak time of the disease before COVID-19. We also calculated the oscillatory strength before and after the COVID-19 outbreak and found that it was significantly stronger before the COVID-19 outbreak and does not correlate with the trough amplitude. Conclusions: Our results directly demonstrate that prevention policies for COVID-19 have immediate additional benefits for controlling most class B infectious diseases, and several factors (infection selectivity, preferred outbreak time) may have contributed to the reduction in outbreaks. This study may guide the implementation of nonpharmaceutical interventions to control a wider range of infectious diseases. UR - https://publichealth.jmir.org/2022/6/e35343 UR - http://dx.doi.org/10.2196/35343 UR - http://www.ncbi.nlm.nih.gov/pubmed/35649394 ID - info:doi/10.2196/35343 ER - TY - JOUR AU - Phoo, Nge Nang Nge AU - Lobo, Roanna AU - Vujcich, Daniel AU - Reid, Alison PY - 2022/5/31 TI - Comparison of the ACASI Mode to Other Survey Modes in Sexual Behavior Surveys in Asia and Sub-Saharan Africa: Systematic Literature Review JO - J Med Internet Res SP - e37356 VL - 24 IS - 5 KW - ACASI KW - survey mode KW - sexual behaviors KW - HIV KW - STI KW - hepatitis KW - blood-borne virus KW - Asia KW - sub-Saharan Africa KW - review N2 - Background: Reliable data about sexual behaviors is fundamental in the prevention and control of HIV, hepatitis, and other sexually transmitted infections. Generally, sexual behaviors are regarded as a sociocultural taboo in Africa and Asia, and this results in biased sexual behavior survey data due to social desirability. Various modes of survey delivery, including audio computer-assisted self-interviews (ACASIs), have been investigated to improve data quality. Objective: This study aimed to review studies that compared the ACASI mode to other survey modes in sexual behavior surveys in Asia and sub-Saharan Africa to ascertain the impact of survey mode on responses to sexual behavior questions. Methods: A systematic literature review was conducted according to the Joanna Briggs Institute Manual for Evidence Synthesis. The review protocol was registered at PROSPERO (International Prospective Register of Systematic Reviews). Six databases were searched. Results: A total of 21 papers were included. The face-to-face interview (FTFI) mode was the survey mode most frequently compared to the ACASI mode. Among the most commonly reported outcome variable groups, ACASI participants were more likely to report sexual behaviors, such as ?forced sex,? ?multiple partners,? ?transactional sex,? and ?ever had sex,? as compared to FTFI participants. In addition to the survey mode effect, other factors were found to have had an impact on data quality, for example, participant characteristics, social norms, study design, and data collection setting. Conclusions: Use of ACASIs for administering sexual behavior surveys among populations in Asia and sub-Saharan Africa demonstrated higher reports for some sexual behaviors than the use of FTFIs. More studies that compare the ACASI mode to other survey modes would improve our understanding of the usefulness of ACASIs in sexual behavior surveys in these regions. UR - https://www.jmir.org/2022/5/e37356 UR - http://dx.doi.org/10.2196/37356 UR - http://www.ncbi.nlm.nih.gov/pubmed/35639465 ID - info:doi/10.2196/37356 ER - TY - JOUR AU - Hammond, M. Michael AU - Zhang, Yuankai AU - Pathiravasan, H. Chathurangi AU - Lin, Honghuang AU - Sardana, Mayank AU - Trinquart, Ludovic AU - Benjamin, J. Emelia AU - Borrelli, Belinda AU - Manders, S. Emily AU - Fusco, Kelsey AU - Kornej, Jelena AU - Spartano, L. Nicole AU - Kheterpal, Vik AU - Nowak, Christopher AU - McManus, D. David AU - Liu, Chunyu AU - Murabito, M. Joanne PY - 2022/4/27 TI - Relations Between BMI Trajectories and Habitual Physical Activity Measured by a Smartwatch in the Electronic Cohort of the Framingham Heart Study: Cohort Study JO - JMIR Cardio SP - e32348 VL - 6 IS - 1 KW - mobile health KW - BMI KW - smartwatch KW - physical activity KW - cardiovascular diseases KW - cardiology KW - digital health KW - mHealth KW - mobile health apps N2 - Background: The prevalence of obesity is rising. Most previous studies that examined the relations between BMI and physical activity (PA) measured BMI at a single timepoint. The association between BMI trajectories and habitual PA remains unclear. Objective: This study assesses the relations between BMI trajectories and habitual step-based PA among participants enrolled in the electronic cohort of the Framingham Heart Study (eFHS). Methods: We used a semiparametric group-based modeling to identify BMI trajectories from eFHS participants who attended research examinations at the Framingham Research Center over 14 years. Daily steps were recorded from the smartwatch provided at examination 3. We excluded participants with <30 days or <5 hours of smartwatch wear data. We used generalized linear models to examine the association between BMI trajectories and daily step counts. Results: We identified 3 trajectory groups for the 837 eFHS participants (mean age 53 years; 57.8% [484/837] female). Group 1 included 292 participants whose BMI was stable (slope 0.005; P=.75), group 2 included 468 participants whose BMI increased slightly (slope 0.123; P<.001), and group 3 included 77 participants whose BMI increased greatly (slope 0.318; P<.001). The median follow-up period for step count was 516 days. Adjusting for age, sex, wear time, and cohort, participants in groups 2 and 3 took 422 (95% CI ?823 to ?21) and 1437 (95% CI ?2084 to ?790) fewer average daily steps, compared with participants in group 1. After adjusting for metabolic and social risk factors, group 2 took 382 (95% CI ?773 to 10) and group 3 took 1120 (95% CI ?1766 to ?475) fewer steps, compared with group 1. Conclusions: In this community-based eFHS, participants whose BMI trajectory increased greatly over time took significantly fewer steps, compared with participants with stable BMI trajectories. Our findings suggest that greater weight gain may correlate with lower levels of step-based physical activity. UR - https://cardio.jmir.org/2022/1/e32348 UR - http://dx.doi.org/10.2196/32348 UR - http://www.ncbi.nlm.nih.gov/pubmed/35476038 ID - info:doi/10.2196/32348 ER - TY - JOUR AU - Kisch, Mark AU - Håkansson, Anders PY - 2022/4/22 TI - Associations Between Addictive Behaviors, Individual Characteristics, and the Use of Gambling Services Within the World of Gaming: Cross-sectional Survey Study JO - JMIR Serious Games SP - e29077 VL - 10 IS - 2 KW - gambling disorder KW - gaming disorder KW - behavioral addiction KW - mental health KW - gambling KW - gaming KW - addiction KW - behavior KW - cross-sectional KW - online survey KW - age KW - gender N2 - Background: Gambling within the world of gaming is an emerging phenomenon that may share common conceptual characteristics with traditional forms of gambling. The current literature suggests a higher degree of problematic behaviors in this gambling pattern, but studies are few, prompting for further research regarding individual characteristics and comorbid conditions associated with this activity. Objective: The aim of the study is to investigate correlations between the use of gambling services within the world of gaming and individual characteristics and addictive behaviors including problem gambling. Methods: A cross-sectional web survey was distributed to an existing panel of online respondents in Sweden. A total of 2001 respondents were included. Chi-square and Mann-Whitney U tests, followed by a logistic regression, were used in order to determine independent variables associated with gambling in the context of gaming. Results: A total of 2.9% (58/1984) of respondents reported past-year gambling within gaming. Significant associations were found with male sex, younger age, history of treatment-seeking for alcohol problems, and higher Gaming Addiction Scale scores. Conclusions: The demonstrated findings strengthen previously found associations between gambling in gaming and younger age, male sex, and problematic gaming behaviors. Additionally, the association with a history of treatment needs for alcohol problems adds to the previous impression of increased problem severity and comorbidity in within-gaming gamblers. UR - https://games.jmir.org/2022/2/e29077 UR - http://dx.doi.org/10.2196/29077 UR - http://www.ncbi.nlm.nih.gov/pubmed/35451974 ID - info:doi/10.2196/29077 ER - TY - JOUR AU - Puga, B. Troy AU - Schafer, Joshua AU - Agbedanu, N. Prince AU - Treffer, Kevin PY - 2022/4/22 TI - COVID-19 Return to Sport: NFL Injury Prevalence Analysis JO - JMIRx Med SP - e35862 VL - 3 IS - 2 KW - COVID-19 KW - sport KW - injury KW - prevalence KW - cause KW - data KW - statistics KW - pain KW - training KW - practice KW - physiology KW - adaptation N2 - 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. UR - https://med.jmirx.org/2022/2/e35862 UR - http://dx.doi.org/10.2196/35862 UR - http://www.ncbi.nlm.nih.gov/pubmed/35511457 ID - info:doi/10.2196/35862 ER - TY - JOUR AU - Bukten, Anne AU - Lokdam, Toresen Nicoline AU - Skjærvø, Ingeborg AU - Ugelvik, Thomas AU - Skurtveit, Svetlana AU - Gabrhelík, Roman AU - Skardhamar, Torbjørn AU - Lund, Olea Ingunn AU - Havnes, Amalia Ingrid AU - Rognli, Borger Eline AU - Chang, Zheng AU - Fazel, Seena AU - Friestad, Christine AU - Hesse, Morten AU - Lothe, Johan AU - Ploeg, Gerhard AU - Dirkzwager, E. Anja J. AU - Clausen, Thomas AU - Tjagvad, Christian AU - Stavseth, Riksheim Marianne PY - 2022/3/23 TI - PriSUD-Nordic?Diagnosing and Treating Substance Use Disorders in the Prison Population: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e35182 VL - 11 IS - 3 KW - substance use disorders KW - prison KW - criminal justice KW - epidemiology KW - mixed methods KW - harm reduction KW - treatment N2 - Background: A large proportion of the prison population experiences substance use disorders (SUDs), which are associated with poor physical and mental health, social marginalization, and economic disadvantage. Despite the global situation characterized by the incarceration of large numbers of people with SUD and the health problems associated with SUD, people in prison are underrepresented in public health research. Objective: The overall objective of the PriSUD (Diagnosing and Treating Substance Use Disorders in Prison)-Nordic project is to develop new knowledge that will contribute to better mental and physical health, improved quality of life, and better life expectancies among people with SUD in prison. Methods: PriSUD-Nordic is based on a multidisciplinary mixed method approach, including the methodological perspectives of both quantitative and qualitative methods. The qualitative part includes ethnographic fieldwork and semistructured interviews. The quantitative part is a registry-based cohort study including national registry data from Norway, Denmark, and Sweden. The national prison cohorts will comprise approximately 500,000 individuals and include all people imprisoned in Norway, Sweden, and Demark during the period from 2000 to 2019. The project will investigate the prison population during three different time periods: before imprisonment, during imprisonment, and after release. Results: PriSUD-Nordic was funded by The Research Council of Norway in December 2019, and funding started in 2020. Data collection is ongoing and will be completed in the first quarter of 2022. Data will be analyzed in spring 2022 and the results will be disseminated in 2022-2023. The PriSUD-Nordic project has formal ethical approval related to all work packages. Conclusions: PriSUD-Nordic will be the first research project to investigate the epidemiology and the lived experiences of people with SUD in the Nordic prison population. Successful research in this field will have the potential to identify significant areas of benefit and will have important implications for ongoing policy related to interventions for SUD in the prison population. International Registered Report Identifier (IRRID): DERR1-10.2196/35182 UR - https://www.researchprotocols.org/2022/3/e35182 UR - http://dx.doi.org/10.2196/35182 UR - http://www.ncbi.nlm.nih.gov/pubmed/35320114 ID - info:doi/10.2196/35182 ER - TY - JOUR AU - Xia, Joyce AU - Melian, Christina AU - Guo, William AU - Usmani, Hunya AU - Clark, Richard AU - Lozeau, Daniel PY - 2022/3/16 TI - Vitiligo and Metabolic Syndrome: Systematic Review and Meta-Analysis JO - JMIR Dermatol SP - e34772 VL - 5 IS - 1 KW - vitiligo KW - leukoderma KW - metabolic syndrome X KW - dysmetabolic syndrome X KW - insulin resistance syndrome X KW - syndrome X N2 - Background: Metabolic syndrome (MetS) has been associated with various skin conditions including vitiligo. However, the association between these 2 conditions has yet to be determined by quantitative meta-analysis. Objective: The aim of this paper was to determine the association between vitiligo and metabolic syndrome via systematic review and meta-analysis. Methods: A systematic literature search of Pubmed, Embase, Cochrane, and Web of Science was performed for all published literature prior to August 16, 2020. Case control and prospective cross-sectional studies analyzing the association between vitiligo and MetS were included in this review. The primary outcome measures include the type of vitiligo, diagnostic criteria for MetS, components of MetS (waist circumference, blood pressure, triglycerides, fasting glycemic index, and high-density lipoprotein cholesterol), low-density lipoprotein cholesterol levels, and BMI. A meta-analysis was performed to evaluate the prevalence and association of MetS in patients with vitiligo. Results: A total of 6 studies (n=734 participants) meeting eligibility criteria were included for systematic review and meta-analysis. The pooled prevalence of MetS in patients with vitiligo was (0.296, 95% CI 0.206, 0.386; P<.001). Patients with vitiligo were no more likely to develop MetS compared to control patients (odds ratio 1.66, 95% CI 0.83, 3.33; P=.01). A leave-one-out sensitivity analysis showed a significant association between MetS and vitiligo (P<.001). Significant elevations in fasting glycemic index (mean difference 5.35, 95% CI 2.77, 7.93; P<.001) and diastolic blood pressure (mean difference 1.97, 95% CI 0.02, 3.92; P=.05) were observed in patients with vitiligo compared to control patients. Conclusions: The association between vitiligo and metabolic syndrome carries important clinical implications. Dermatologists and other multidisciplinary team members should remain vigilant when treating this patient population in order to prevent serious cardiovascular complications that may arise as a result of metabolic disease. UR - https://derma.jmir.org/2022/1/e34772 UR - http://dx.doi.org/10.2196/34772 UR - http://www.ncbi.nlm.nih.gov/pubmed/37632859 ID - info:doi/10.2196/34772 ER - TY - JOUR AU - Wang, Liya AU - Qiu, Hang AU - Luo, Li AU - Zhou, Li PY - 2022/2/25 TI - Age- and Sex-Specific Differences in Multimorbidity Patterns and Temporal Trends on Assessing Hospital Discharge Records in Southwest China: Network-Based Study JO - J Med Internet Res SP - e27146 VL - 24 IS - 2 KW - multimorbidity pattern KW - temporal trend KW - network analysis KW - multimorbidity prevalence KW - administrative data KW - longitudinal study KW - regional research N2 - Background: Multimorbidity represents a global health challenge, which requires a more global understanding of multimorbidity patterns and trends. However, the majority of studies completed to date have often relied on self-reported conditions, and a simultaneous assessment of the entire spectrum of chronic disease co-occurrence, especially in developing regions, has not yet been performed. Objective: We attempted to provide a multidimensional approach to understand the full spectrum of chronic disease co-occurrence among general inpatients in southwest China, in order to investigate multimorbidity patterns and temporal trends, and assess their age and sex differences. Methods: We conducted a retrospective cohort analysis based on 8.8 million hospital discharge records of about 5.0 million individuals of all ages from 2015 to 2019 in a megacity in southwest China. We examined all chronic diagnoses using the ICD-10 (International Classification of Diseases, 10th revision) codes at 3 digits and focused on chronic diseases with ?1% prevalence for each of the age and sex strata, which resulted in a total of 149 and 145 chronic diseases in males and females, respectively. We constructed multimorbidity networks in the general population based on sex and age, and used the cosine index to measure the co-occurrence of chronic diseases. Then, we divided the networks into communities and assessed their temporal trends. Results: The results showed complex interactions among chronic diseases, with more intensive connections among males and inpatients ?40 years old. A total of 9 chronic diseases were simultaneously classified as central diseases, hubs, and bursts in the multimorbidity networks. Among them, 5 diseases were common to both males and females, including hypertension, chronic ischemic heart disease, cerebral infarction, other cerebrovascular diseases, and atherosclerosis. The earliest leaps (degree leaps ?6) appeared at a disorder of glycoprotein metabolism that happened at 25-29 years in males, about 15 years earlier than in females. The number of chronic diseases in the community increased over time, but the new entrants did not replace the root of the community. Conclusions: Our multimorbidity network analysis identified specific differences in the co-occurrence of chronic diagnoses by sex and age, which could help in the design of clinical interventions for inpatient multimorbidity. UR - https://www.jmir.org/2022/2/e27146 UR - http://dx.doi.org/10.2196/27146 UR - http://www.ncbi.nlm.nih.gov/pubmed/35212632 ID - info:doi/10.2196/27146 ER - TY - JOUR AU - He, Fan AU - Blackberry, Irene AU - Yao, Liqing AU - Xie, Haiyan AU - Mnatzaganian, George PY - 2022/1/18 TI - Geographical Disparities in Pooled Stroke Incidence and Case Fatality in Mainland China, Hong Kong, and Macao: Protocol for a Systematic Review and Meta-analysis JO - JMIR Res Protoc SP - e32566 VL - 11 IS - 1 KW - case fatality KW - Hong Kong KW - incidence KW - Mainland China KW - Macao KW - meta-analysis KW - stroke KW - systematic review KW - stroke incidence KW - mortality rates KW - epidemiology N2 - Background: Geographical variations in stroke incidence and case fatality in China have been reported. Nonetheless, pooled estimates in major Chinese regions are unknown. Objective: This systematic review and meta-analysis aims to investigate pooled estimates of incidence and short-term case fatality of stroke in Mainland China, Hong Kong, and Macao. Methods: Longitudinal studies published in English and indexed in PubMed/MEDLINE, Embase, CINAHL, and Web of Science, or in Chinese and indexed in SinoMed and CQVIP will be targeted. Articles reporting on adults living in China who experience first-ever stroke or die within 1 year from newly onset stroke will be included. The 95% confidence intervals of the event will be estimated using the exact method based on the Poisson distribution. The log incidence rates together with their corresponding log standard errors will be meta-analyzed using DerSimonian and Laird random effects models. Pooled case fatality rates will also be estimated using a random effect model. Time trends in pooled age-standardized stroke incidence and case fatality will be estimated. The heterogeneity of the included studies will be measured using the I2 statistic and meta-regressions will be run to analyze the effect of reported covariates on found heterogeneity. Risk of bias will be examined using the Newcastle-Ottawa Scale. Publication bias will be tested using funnel plots and Egger tests. Sensitivity analysis will be run by risk of bias. Results: This study was funded and registered in 2020. The systematic searches, study selections, and quality assessments were completed in July 2021. Data extraction and analysis and manuscript writing are scheduled to be completed by December 2021. Conclusions: This will be the first study to provide regional differences in pooled estimates of stroke incidence with case fatality in Mainland China, Hong Kong, and Macao. This study will assist in addressing inequalities in stroke care across China. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020170724; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=170724 International Registered Report Identifier (IRRID): PRR1-10.2196/32566 UR - https://www.researchprotocols.org/2022/1/e32566 UR - http://dx.doi.org/10.2196/32566 UR - http://www.ncbi.nlm.nih.gov/pubmed/35040797 ID - info:doi/10.2196/32566 ER - TY - JOUR AU - Devriendt, Thijs AU - Borry, Pascal AU - Shabani, Mahsa PY - 2022/1/13 TI - Credit and Recognition for Contributions to Data-Sharing Platforms Among Cohort Holders and Platform Developers in Europe: Interview Study JO - J Med Internet Res SP - e25983 VL - 24 IS - 1 KW - information dissemination KW - qualitative research KW - ethics KW - database management systems KW - cohort studies KW - science policy KW - incentives KW - rewards N2 - Background: The European Commission is funding projects that aim to establish data-sharing platforms. These platforms are envisioned to enhance and facilitate the international sharing of cohort data. Nevertheless, broad data sharing may be restricted by the lack of adequate recognition for those who share data. Objective: The aim of this study is to describe in depth the concerns about acquiring credit for data sharing within epidemiological research. Methods: A total of 17 participants linked to European Union?funded data-sharing platforms were recruited for a semistructured interview. Transcripts were analyzed using inductive content analysis. Results: Interviewees argued that data sharing within international projects could challenge authorship guidelines in multiple ways. Some respondents considered that the acquisition of credit for articles with extensive author lists could be problematic in some instances, such as for junior researchers. In addition, universities may be critical of researchers who share data more often than leading research. Some considered that the evaluation system undervalues data generators and specialists. Respondents generally looked favorably upon alternatives to the current evaluation system to potentially ameliorate these issues. Conclusions: The evaluation system might impede data sharing because it mainly focuses on first and last authorship and undervalues the contributor?s work. Further movement of crediting models toward contributorship could potentially address this issue. Appropriate crediting mechanisms that are better aligned with the way science ought to be conducted in the future need to be developed. UR - https://www.jmir.org/2022/1/e25983 UR - http://dx.doi.org/10.2196/25983 UR - http://www.ncbi.nlm.nih.gov/pubmed/35023849 ID - info:doi/10.2196/25983 ER - TY - JOUR AU - Lystad, P. Reidar AU - Fajardo Pulido, Diana AU - Peters, Lorna AU - Johnstone, Melissa AU - Ellis, A. Louise AU - Braithwaite, Jeffrey AU - Wuthrich, Viviana AU - Amin, Janaki AU - Cameron, M. Cate AU - Mitchell, J. Rebecca PY - 2022/1/6 TI - Feasibility of Monitoring Health and Well-being in Emerging Adults: Pilot Longitudinal Cohort Study JO - JMIR Form Res SP - e30027 VL - 6 IS - 1 KW - young adult KW - emerging adulthood KW - health KW - well-being KW - health-related quality of life KW - feasibility KW - monitoring KW - pilot study KW - longitudinal KW - cohort KW - youth KW - acceptability KW - survey KW - quality of life N2 - Background: Emerging adulthood is a distinct segment of an individual?s life course. The defining features of this transitional period include identity exploration, instability, future possibilities, self-focus, and feeling in-between, all of which are thought to affect quality of life, health, and well-being. A longitudinal cohort study with a comprehensive set of measures would be a valuable resource for improving the understanding of the multifaceted elements and unique challenges that contribute to the health and well-being of emerging adults. Objective: The main aim of this pilot study was to evaluate the feasibility and acceptability of recruiting university graduates to establish a longitudinal cohort study to inform the understanding of emerging adulthood. Methods: This pilot study was conducted among graduates at a large university. It involved collecting web-based survey data at baseline (ie, graduation) and 12 months post baseline, and linking survey responses to health records from administrative data collections. The feasibility outcome measures of interest included the recruitment rate, response rate, retention rate, data linkage opt-out rate, and availability of linked health records. Descriptive statistics were used to evaluate the representativeness of the sample, completeness of the survey responses, and data linkage characteristics. Results: Only 2.8% of invited graduates (238/8532) agreed to participate in this pilot cohort study, of whom 59.7% (142/238) responded to the baseline survey. The retention rate between the baseline and follow-up surveys was 69.7% (99/142). The completeness of the surveys was excellent, with the proportion of answered questions in each survey domain ranging from 87.3% to 100% in both the baseline and follow-up surveys. The data linkage opt-out rate was 32.4% (77/238). Conclusions: The overall recruitment rate was poor, while the completeness of survey responses among respondents ranged from good to excellent. There was reasonable acceptability for conducting data linkage of health records from administrative data collections and survey responses. This pilot study offers insights and recommendations for future research aiming to establish a longitudinal cohort study to investigate health and well-being in emerging adults. Trial Registration: Australian New Zealand Clinical Trials Registry number ACTRN12618001364268; https://tinyurl.com/teec8wh International Registered Report Identifier (IRRID): RR2-10.2196/16108 UR - https://formative.jmir.org/2022/1/e30027 UR - http://dx.doi.org/10.2196/30027 UR - http://www.ncbi.nlm.nih.gov/pubmed/34989696 ID - info:doi/10.2196/30027 ER - TY - JOUR AU - Horvath, Correia Jaqueline Driemeyer AU - Bessel, Marina AU - Kops, Luiza Natália AU - Souza, Alves Flávia Moreno AU - Pereira, Mendes Gerson AU - Wendland, Marcia Eliana PY - 2022/1/5 TI - A Nationwide Evaluation of the Prevalence of Human Papillomavirus in Brazil (POP-Brazil Study): Protocol for Data Quality Assurance and Control JO - JMIR Res Protoc SP - e31365 VL - 11 IS - 1 KW - quality control KW - quality assurance KW - evidence-based medicine KW - quality data N2 - Background: The credibility of a study and its internal and external validity depend crucially on the quality of the data produced. An in-depth knowledge of quality control processes is essential as large and integrative epidemiological studies are increasingly prioritized. Objective: This study aimed to describe the stages of quality control in the POP-Brazil study and to present an analysis of the quality indicators. Methods: Quality assurance and control were initiated with the planning of this nationwide, multicentric study and continued through the development of the project. All quality control protocol strategies, such as training, protocol implementation, audits, and inspection, were discussed one by one. We highlight the importance of conducting a pilot study that provides the researcher the opportunity to refine or modify the research methodology and validating the results through double data entry, test-retest, and analysis of nonresponse rates. Results: This cross-sectional, nationwide, multicentric study recruited 8628 sexually active young adults (16-25 years old) in 119 public health units between September 2016 and November 2017. The Human Research Ethics Committee of the Moinhos de Vento Hospital approved this project. Conclusions: Quality control processes are a continuum, not restricted to a single event, and are fundamental to the success of data integrity and the minimization of bias in epidemiological studies. The quality control steps described can be used as a guide to implement evidence-based, valid, reliable, and useful procedures in most observational studies to ensure data integrity. International Registered Report Identifier (IRRID): RR1-10.2196/31365 UR - https://www.researchprotocols.org/2022/1/e31365 UR - http://dx.doi.org/10.2196/31365 UR - http://www.ncbi.nlm.nih.gov/pubmed/34989680 ID - info:doi/10.2196/31365 ER - TY - JOUR AU - Aguayo, A. Gloria AU - Goetzinger, Catherine AU - Scibilia, Renza AU - Fischer, Aurélie AU - Seuring, Till AU - Tran, Viet-Thi AU - Ravaud, Philippe AU - Bereczky, Tamás AU - Huiart, Laetitia AU - Fagherazzi, Guy PY - 2021/12/23 TI - Methods to Generate Innovative Research Ideas and Improve Patient and Public Involvement in Modern Epidemiological Research: Review, Patient Viewpoint, and Guidelines for Implementation of a Digital Cohort Study JO - J Med Internet Res SP - e25743 VL - 23 IS - 12 KW - patient and public involvement KW - workshops KW - surveys KW - focus groups KW - co-design KW - digital cohort study KW - digital epidemiology KW - social media KW - mobile phone N2 - Background: Patient and public involvement (PPI) in research aims to increase the quality and relevance of research by incorporating the perspective of those ultimately affected by the research. Despite these potential benefits, PPI is rarely included in epidemiology protocols. Objective: The aim of this study is to provide an overview of methods used for PPI and offer practical recommendations for its efficient implementation in epidemiological research. Methods: We conducted a review on PPI methods. We mirrored it with a patient advocate?s viewpoint about PPI. We then identified key steps to optimize PPI in epidemiological research based on our review and the viewpoint of the patient advocate, taking into account the identification of barriers to, and facilitators of, PPI. From these, we provided practical recommendations to launch a patient-centered cohort study. We used the implementation of a new digital cohort study as an exemplary use case. Results: We analyzed data from 97 studies, of which 58 (60%) were performed in the United Kingdom. The most common methods were workshops (47/97, 48%); surveys (33/97, 34%); meetings, events, or conferences (28/97, 29%); focus groups (25/97, 26%); interviews (23/97, 24%); consensus techniques (8/97, 8%); James Lind Alliance consensus technique (7/97, 7%); social media analysis (6/97, 6%); and experience-based co-design (3/97, 3%). The viewpoint of a patient advocate showed a strong interest in participating in research. The most usual PPI modalities were research ideas (60/97, 62%), co-design (42/97, 43%), defining priorities (31/97, 32%), and participation in data analysis (25/97, 26%). We identified 9 general recommendations and 32 key PPI-related steps that can serve as guidelines to increase the relevance of epidemiological studies. Conclusions: PPI is a project within a project that contributes to improving knowledge and increasing the relevance of research. PPI methods are mainly used for idea generation. On the basis of our review and case study, we recommend that PPI be included at an early stage and throughout the research cycle and that methods be combined for generation of new ideas. For e-cohorts, the use of digital tools is essential to scale up PPI. We encourage investigators to rely on our practical recommendations to extend PPI in future epidemiological studies. UR - https://www.jmir.org/2021/12/e25743 UR - http://dx.doi.org/10.2196/25743 UR - http://www.ncbi.nlm.nih.gov/pubmed/34941554 ID - info:doi/10.2196/25743 ER - TY - JOUR AU - Husnayain, Atina AU - Shim, Eunha AU - Fuad, Anis AU - Su, Chia-Yu Emily PY - 2021/12/22 TI - Predicting New Daily COVID-19 Cases and Deaths Using Search Engine Query Data in South Korea From 2020 to 2021: Infodemiology Study JO - J Med Internet Res SP - e34178 VL - 23 IS - 12 KW - prediction KW - internet search KW - COVID-19 KW - South Korea KW - infodemiology N2 - Background: Given the ongoing COVID-19 pandemic situation, accurate predictions could greatly help in the health resource management for future waves. However, as a new entity, COVID-19?s disease dynamics seemed difficult to predict. External factors, such as internet search data, need to be included in the models to increase their accuracy. However, it remains unclear whether incorporating online search volumes into models leads to better predictive performances for long-term prediction. Objective: The aim of this study was to analyze whether search engine query data are important variables that should be included in the models predicting new daily COVID-19 cases and deaths in short- and long-term periods. Methods: We used country-level case-related data, NAVER search volumes, and mobility data obtained from Google and Apple for the period of January 20, 2020, to July 31, 2021, in South Korea. Data were aggregated into four subsets: 3, 6, 12, and 18 months after the first case was reported. The first 80% of the data in all subsets were used as the training set, and the remaining data served as the test set. Generalized linear models (GLMs) with normal, Poisson, and negative binomial distribution were developed, along with linear regression (LR) models with lasso, adaptive lasso, and elastic net regularization. Root mean square error values were defined as a loss function and were used to assess the performance of the models. All analyses and visualizations were conducted in SAS Studio, which is part of the SAS OnDemand for Academics. Results: GLMs with different types of distribution functions may have been beneficial in predicting new daily COVID-19 cases and deaths in the early stages of the outbreak. Over longer periods, as the distribution of cases and deaths became more normally distributed, LR models with regularization may have outperformed the GLMs. This study also found that models performed better when predicting new daily deaths compared to new daily cases. In addition, an evaluation of feature effects in the models showed that NAVER search volumes were useful variables in predicting new daily COVID-19 cases, particularly in the first 6 months of the outbreak. Searches related to logistical needs, particularly for ?thermometer? and ?mask strap,? showed higher feature effects in that period. For longer prediction periods, NAVER search volumes were still found to constitute an important variable, although with a lower feature effect. This finding suggests that search term use should be considered to maintain the predictive performance of models. Conclusions: NAVER search volumes were important variables in short- and long-term prediction, with higher feature effects for predicting new daily COVID-19 cases in the first 6 months of the outbreak. Similar results were also found for death predictions. UR - https://www.jmir.org/2021/12/e34178 UR - http://dx.doi.org/10.2196/34178 UR - http://www.ncbi.nlm.nih.gov/pubmed/34762064 ID - info:doi/10.2196/34178 ER - TY - JOUR AU - Lee, Megan AU - Sallah, Haddy Ya AU - Petrone, Mary AU - Ringer, Matthew AU - Cosentino, Danielle AU - Vogels, F. Chantal B. AU - Fauver, R. Joseph AU - Alpert, D. Tara AU - Grubaugh, D. Nathan AU - Gupta, Shaili PY - 2021/12/17 TI - COVID-19 Outcomes and Genomic Characterization of SARS-CoV-2 Isolated From Veterans in New England States: Retrospective Analysis JO - JMIRx Med SP - e31503 VL - 2 IS - 4 KW - infectious disease KW - COVID-19 KW - epidemiology KW - veteran KW - outcome KW - sequencing KW - genetics KW - virus KW - United States KW - impact KW - testing KW - severity KW - mortality KW - cohort N2 - Background: Clinical and virologic characteristics of COVID-19 infections in veterans in New England have not been described. The average US veteran is a male older than the general US population. SARS-CoV-2 infection is known to cause poorer outcomes among men and older adults, making the veteran population an especially vulnerable group for COVID-19. Objective: This study aims to evaluate clinical and virologic factors impacting COVID-19 outcomes. Methods: This retrospective chart review included 476 veterans in six New England states with confirmed SARS-CoV-2 infection between April and September 2020. Whole genome sequencing was performed on SARS-CoV-2 RNA isolated from these veterans, and the correlation of genomic data to clinical outcomes was evaluated. Clinical and demographic variables were collected by manual chart review and were correlated to the end points of peak disease severity (based on oxygenation requirements), hospitalization, and mortality using multivariate regression analyses. Results: Of 476 veterans, 274 had complete and accessible charts. Of the 274 veterans, 92.7% (n=254) were men and 83.2% (n=228) were White, and the mean age was 63 years. In the multivariate regression, significant predictors of hospitalization (C statistic 0.75) were age (odds ratio [OR] 1.05, 95% CI 1.03-1.08) and non-White race (OR 2.39, 95% CI 1.13-5.01). Peak severity (C statistic 0.70) also varied by age (OR 1.07, 95% CI 1.03-1.11) and O2 requirement on admission (OR 45.7, 95% CI 18.79-111). Mortality (C statistic 0.87) was predicted by age (OR 1.06, 95% CI 1.01-1.11), dementia (OR 3.44, 95% CI 1.07-11.1), and O2 requirement on admission (OR 6.74, 95% CI 1.74-26.1). Most (291/299, 97.3%) of our samples were dominated by the spike protein D614G substitution and were from SARS-CoV-2 B.1 lineage or one of 37 different B.1 sublineages, with none representing more than 8.7% (26/299) of the cases. Conclusions: In a cohort of veterans from the six New England states with a mean age of 63 years and a high comorbidity burden, age was the largest predictor of hospitalization, peak disease severity, and mortality. Non-White veterans were more likely to be hospitalized, and patients who required oxygen on admission were more likely to have severe disease and higher rates of mortality. Multiple SARS-CoV-2 lineages were distributed in patients in New England early in the COVID-19 era, mostly related to viruses from New York State with D614G mutation. UR - https://med.jmirx.org/2021/4/e31503 UR - http://dx.doi.org/10.2196/31503 UR - http://www.ncbi.nlm.nih.gov/pubmed/35014989 ID - info:doi/10.2196/31503 ER - TY - JOUR AU - Whitton, Clare AU - Healy, D. Janelle AU - Collins, E. Clare AU - Mullan, Barbara AU - Rollo, E. Megan AU - Dhaliwal, S. Satvinder AU - Norman, Richard AU - Boushey, J. Carol AU - Delp, J. Edward AU - Zhu, Fengqing AU - McCaffrey, A. Tracy AU - Kirkpatrick, I. Sharon AU - Atyeo, Paul AU - Mukhtar, Aqif Syed AU - Wright, L. Janine AU - Ramos-García, César AU - Pollard, M. Christina AU - Kerr, A. Deborah PY - 2021/12/16 TI - Accuracy and Cost-effectiveness of Technology-Assisted Dietary Assessment Comparing the Automated Self-administered Dietary Assessment Tool, Intake24, and an Image-Assisted Mobile Food Record 24-Hour Recall Relative to Observed Intake: Protocol for a Randomized Crossover Feeding Study JO - JMIR Res Protoc SP - e32891 VL - 10 IS - 12 KW - 24-hour recall KW - Automated Self-Administered Dietary Assessment Tool KW - Intake24 KW - mobile food record KW - image-assisted dietary assessment KW - validation KW - controlled feeding KW - accuracy KW - dietary measurement error KW - self-report KW - energy intake KW - adult KW - cost-effectiveness KW - acceptability KW - mobile technology KW - diet surveys KW - mobile phone N2 - Background: The assessment of dietary intake underpins population nutrition surveillance and nutritional epidemiology and is essential to inform effective public health policies and programs. Technological advances in dietary assessment that use images and automated methods have the potential to improve accuracy, respondent burden, and cost; however, they need to be evaluated to inform large-scale use. Objective: The aim of this study is to compare the accuracy, acceptability, and cost-effectiveness of 3 technology-assisted 24-hour dietary recall (24HR) methods relative to observed intake across 3 meals. Methods: Using a controlled feeding study design, 24HR data collected using 3 methods will be obtained for comparison with observed intake. A total of 150 healthy adults, aged 18 to 70 years, will be recruited and will complete web-based demographic and psychosocial questionnaires and cognitive tests. Participants will attend a university study center on 3 separate days to consume breakfast, lunch, and dinner, with unobtrusive documentation of the foods and beverages consumed and their amounts. Following each feeding day, participants will complete a 24HR process using 1 of 3 methods: the Automated Self-Administered Dietary Assessment Tool, Intake24, or the Image-Assisted mobile Food Record 24-Hour Recall. The sequence of the 3 methods will be randomized, with each participant exposed to each method approximately 1 week apart. Acceptability and the preferred 24HR method will be assessed using a questionnaire. Estimates of energy, nutrient, and food group intake and portion sizes from each 24HR method will be compared with the observed intake for each day. Linear mixed models will be used, with 24HR method and method order as fixed effects, to assess differences in the 24HR methods. Reporting bias will be assessed by examining the ratios of reported 24HR intake to observed intake. Food and beverage omission and intrusion rates will be calculated, and differences by 24HR method will be assessed using chi-square tests. Psychosocial, demographic, and cognitive factors associated with energy misestimation will be evaluated using chi-square tests and multivariable logistic regression. The financial costs, time costs, and cost-effectiveness of each 24HR method will be assessed and compared using repeated measures analysis of variance tests. Results: Participant recruitment commenced in March 2021 and is planned to be completed by the end of 2021. Conclusions: This protocol outlines the methodology of a study that will evaluate the accuracy, acceptability, and cost-effectiveness of 3 technology-enabled dietary assessment methods. This will inform the selection of dietary assessment methods in future studies on nutrition surveillance and epidemiology. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000209897; https://tinyurl.com/2p9fpf2s International Registered Report Identifier (IRRID): DERR1-10.2196/32891 UR - https://www.researchprotocols.org/2021/12/e32891 UR - http://dx.doi.org/10.2196/32891 UR - http://www.ncbi.nlm.nih.gov/pubmed/34924357 ID - info:doi/10.2196/32891 ER - TY - JOUR AU - Young, J. William AU - Bover Manderski, T. Michelle AU - Ganz, Ollie AU - Delnevo, D. Cristine AU - Hrywna, Mary PY - 2021/12/13 TI - Examining the Impact of Question Construction on Reporting of Sexual Identity: Survey Experiment Among Young Adults JO - JMIR Public Health Surveill SP - e32294 VL - 7 IS - 12 KW - survey measurement KW - sexual identity KW - survey wording experiment N2 - Background: Compared with heterosexuals, sexual minorities in the United States experience a higher incidence of negative physical and mental health outcomes. However, a variety of measurement challenges limit researchers? ability to conduct meaningful survey research to understand these disparities. Despite the prevalence of additional identities, many national health surveys only offer respondents 3 substantive options for reporting their sexual identities (straight/heterosexual, gay or lesbian, and bisexual), which could lead to measurement error via misreporting and item nonresponse. Objective: This study compared the traditional 3-option approach to measuring sexual identity with an expanded approach that offered respondents 5 additional options. Methods: An online survey experiment conducted among New Jersey residents between March and June 2021 randomly assigned 1254 young adults (ages 18-21) to answer either the 3-response measure of sexual identity or the expanded item. Response distributions for each measure were compared as were the odds of item nonresponse. Results: The expanded version of the question appeared to result in more accurate reporting among some subgroups and induced less item nonresponse; 12% (77/642) of respondents in the expanded version selected a response that was not available in the shorter version. Females answering the expanded item were less likely to identify as gay or lesbian (2.1% [10/467] vs. 6.6% [30/457]). Females and Non-Hispanic Whites were slightly more likely to skip the shorter version than the longer version (1.1% [5/457 for females and 3/264 for Non-Hispanic Whites] vs. 0% [0/467 for females and 0/277 for Non-Hispanic Whites]). About 5% (32/642) of respondents answering the longer item were unsure of their sexual identity (a similar option was not available in the shorter version). Compared with respondents answering the longer version of the question, those answering the shorter version had substantially greater odds of skipping the question altogether (odds ratio 9.57, 95% CI 1.21-75.74; P=.03). Conclusions: Results favor the use of a longer, more detailed approach to measuring sexual identity in epidemiological research. Such a measure will likely allow researchers to produce more accurate estimates of health behaviors and outcomes among sexual minorities. UR - https://publichealth.jmir.org/2021/12/e32294 UR - http://dx.doi.org/10.2196/32294 UR - http://www.ncbi.nlm.nih.gov/pubmed/34898444 ID - info:doi/10.2196/32294 ER - TY - JOUR AU - Hazenberg, L. Hanna M. J. AU - Dubbink, Henk Jan AU - Sesay, Issa AU - Versteege, Tom AU - Bangura, Hassan AU - Hoevenaars, K. Louise AU - Falama, M. Abdul AU - Koudijs, M. Heleen AU - Roemers, Rosa AU - Bache, B. Emmanuel AU - Kelling, F. Emil AU - Schaumburg, Frieder AU - Spijkervet, L. Fred K. AU - Grobusch, P. Martin PY - 2021/12/13 TI - Complicated Odontogenic Infections at 2 District Hospitals in Tonkolili District, Sierra Leone: Protocol for a Prospective Observational Cohort Study (DELAY) JO - JMIR Res Protoc SP - e33677 VL - 10 IS - 12 KW - complicated odontogenic infection KW - dental abscess KW - deep neck space infection KW - Ludwig angina KW - necrotizing fasciitis KW - prospective observational cohort study N2 - Background: Deficits in global oral health care are paramount, and complications of odontogenic infections constitute a considerable global health problem, particularly in low-income countries. A high mortality rate has been observed for patients who have been admitted with complicated odontogenic infections to our facilities in Tonkolili District, Sierra Leone, although exact data have not been published yet. Data regarding who in this region is at risk and why are lacking. Objective: The Dental Abscess Study (DELAY) aims to prospectively investigate morbidity and mortality from complicated dental abscesses and to analyze patients? characteristics and microbial findings to examine predisposing factors for poor outcomes. In particular, the incidence and the clinical and microbial characteristics of complicated odontogenic infections, as well as the sociodemographic data and comorbidities of affected patients, will be studied to develop improved management algorithms based on circumstance-specific factors. Methods: Patients who present with complicated dental infections requiring hospital admission in Masanga Hospital or Lion Heart Medical Centre will be consecutively selected for possible inclusion in the study (starting on September 4, 2021) over a study period of 1 year, and individual routine follow-ups will be conducted at least 3 months after discharge. The results of standardized questionnaires will be obtained, and clinical measurements as well as medical photos will be taken. Standard laboratory tests (eg, full blood count and HIV status tests) will be performed, and pus specimens will be examined. Local treatment guidelines will be adhered to, and data on medical and surgical treatment as well as data on outcomes will be collected. The study results will be reported according to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) criteria. Routine follow-ups will take place at 1 and 3 months postdischarge. Results: The DELAY protocol was endorsed by the Masanga Medical Research Unit?s Scientific Review Committee on June 16, 2021, and ethical approval was granted on July 5, 2021, by the Sierra Leone National Ethics Committee. The funding of the budgeted study costs was approved by Dental Health International Netherlands in August 2021. The projected start date of data collection was September 4, 2021, and the study period will most likely last for 1 year. As such, data collection is expected to be complete in November 2022. Conclusions: The aim of our prospective observational cohort study is to gain more knowledge about complicated odontogenic infections in Tonkolili District, Sierra Leone, to further improve treatment strategies. International Registered Report Identifier (IRRID): DERR1-10.2196/33677 UR - https://www.researchprotocols.org/2021/12/e33677 UR - http://dx.doi.org/10.2196/33677 UR - http://www.ncbi.nlm.nih.gov/pubmed/34898462 ID - info:doi/10.2196/33677 ER - TY - JOUR AU - Batta, Nisha AU - Shangraw, Sarah AU - Nicklawsky, Andrew AU - Yamauchi, Takeshi AU - Zhai, Zili AU - Ravindran Menon, Dinoop AU - Gao, Dexiang AU - Dellavalle, P. Robert AU - Fujita, Mayumi PY - 2021/12/13 TI - Global Melanoma Correlations With Obesity, Smoking, and Alcohol Consumption JO - JMIR Dermatol SP - e31275 VL - 4 IS - 2 KW - melanoma incidence KW - melanoma mortality KW - non-UV risk factors KW - obesity KW - alcohol consumption KW - smoking KW - wine KW - World Health Organization KW - WHO KW - Global Cancer Observatory KW - GCO KW - Global Health Observatory KW - GHO KW - aldehyde dehydrogenase 2 KW - ALDH2 KW - polymorphism UR - https://derma.jmir.org/2021/2/e31275 UR - http://dx.doi.org/10.2196/31275 UR - http://www.ncbi.nlm.nih.gov/pubmed/35990801 ID - info:doi/10.2196/31275 ER - TY - JOUR AU - Gleason, Neil AU - Serrano, A. Pedro AU - Muñoz, Alejandro AU - French, Audrey AU - Hosek, Sybil PY - 2021/11/26 TI - Limited Interaction Targeted Epidemiology of HIV in Sexual and Gender Minority American Adolescents and Adults: Feasibility of the Keeping it LITE Study JO - JMIR Form Res SP - e30761 VL - 5 IS - 11 KW - social epidemiology KW - adolescents and young adults KW - sexual and gender minorities KW - HIV testing N2 - Background: HIV infection rates among sexual minority men and transgender individuals, particularly adolescents and young adults, remain elevated in the United States despite continued improvement in the HIV public health response. However, there remains a knowledge gap in understanding the barriers faced by this community in receiving HIV care and prevention resources. To address this, the Keeping it LITE study was conducted to assess HIV risk factors and barriers to preventive treatment in a large national cohort of young sexual minority men and transgender individuals at high risk of HIV infection. Objective: This study aims to evaluate the feasibility of enrolling a large remote cohort, challenges encountered in recruitment, and adjustments made to address these challenges. Methods: A large national cohort (n=3444) of young sexual minority men and transgender individuals were recruited. Participants were recruited via advertisements on social media; social apps for lesbian, gay, bisexual, transgender, and queer individuals; print advertising; and word-of-mouth. Before enrolling, participants verified their HIV status using an at-home HIV test or by providing their own testing documentation. Descriptive statistics were generated, and a series of logistic regressions were conducted to evaluate demographic differences between recruitment methods, HIV testing methods, and enrollment status. Results: The Keeping it LITE study was particularly successful in recruiting participants via social media, with over half of the participants recruited from advertisements on social media platforms such as Facebook, Instagram, and Snapchat. Participants were also recruited via word-of-mouth; lesbian, gay, bisexual, transgender, and queer apps (ie, Grindr, Scruff); and print advertisements, and participants recruited from these sources tended to be older and have a higher risk profile. The study was also successful in recruiting a large sample of transgender youth, particularly transgender men and nonbinary individuals. At-home HIV testing was acceptable and more heavily used by younger participants, although several barriers were encountered and overcome in the implementation of this testing. The study had more limited success in recruiting participants aged 13-17 years because of lower enrollment rates and barriers to advertising on social media platforms. The implications of these findings for the future development of HIV research and intervention protocols among sexual minorities and trans youth are discussed. Conclusions: The methods used in the Keeping it LITE study, particularly recruitment via social media, were found to be feasible and acceptable to participants. UR - https://formative.jmir.org/2021/11/e30761 UR - http://dx.doi.org/10.2196/30761 UR - http://www.ncbi.nlm.nih.gov/pubmed/34346403 ID - info:doi/10.2196/30761 ER - TY - JOUR AU - Bhimaraju, Hari AU - Nag, Nitish AU - Pandey, Vaibhav AU - Jain, Ramesh PY - 2021/11/23 TI - Understanding ?Atmosome?, the Personal Atmospheric Exposome: Comprehensive Approach JO - JMIR Biomed Eng SP - e28920 VL - 6 IS - 4 KW - exposome KW - exposomics KW - personal health KW - indoor air quality KW - health state estimation KW - health informatics KW - public health policy KW - epidemiology KW - embedded systems KW - internet of things N2 - 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. UR - https://biomedeng.jmir.org/2021/4/e28920 UR - http://dx.doi.org/10.2196/28920 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/28920 ER - TY - JOUR AU - Leal-Neto, Onicio AU - Egger, Thomas AU - Schlegel, Matthias AU - Flury, Domenica AU - Sumer, Johannes AU - Albrich, Werner AU - Babouee Flury, Baharak AU - Kuster, Stefan AU - Vernazza, Pietro AU - Kahlert, Christian AU - Kohler, Philipp PY - 2021/11/22 TI - Digital SARS-CoV-2 Detection Among Hospital Employees: Participatory Surveillance Study JO - JMIR Public Health Surveill SP - e33576 VL - 7 IS - 11 KW - digital epidemiology KW - SARS-CoV-2 KW - COVID-19 KW - health care workers N2 - Background: The implementation of novel techniques as a complement to traditional disease surveillance systems represents an additional opportunity for rapid analysis. Objective: The objective of this work is to describe a web-based participatory surveillance strategy among health care workers (HCWs) in two Swiss hospitals during the first wave of COVID-19. Methods: A prospective cohort of HCWs was recruited in March 2020 at the Cantonal Hospital of St. Gallen and the Eastern Switzerland Children?s Hospital. For data analysis, we used a combination of the following techniques: locally estimated scatterplot smoothing (LOESS) regression, Spearman correlation, anomaly detection, and random forest. Results: From March 23 to August 23, 2020, a total of 127,684 SMS text messages were sent, generating 90,414 valid reports among 1004 participants, achieving a weekly average of 4.5 (SD 1.9) reports per user. The symptom showing the strongest correlation with a positive polymerase chain reaction test result was loss of taste. Symptoms like red eyes or a runny nose were negatively associated with a positive test. The area under the receiver operating characteristic curve showed favorable performance of the classification tree, with an accuracy of 88% for the training data and 89% for the test data. Nevertheless, while the prediction matrix showed good specificity (80.0%), sensitivity was low (10.6%). Conclusions: Loss of taste was the symptom that was most aligned with COVID-19 activity at the population level. At the individual level?using machine learning?based random forest classification?reporting loss of taste and limb/muscle pain as well as the absence of runny nose and red eyes were the best predictors of COVID-19. UR - https://publichealth.jmir.org/2021/11/e33576 UR - http://dx.doi.org/10.2196/33576 UR - http://www.ncbi.nlm.nih.gov/pubmed/34727046 ID - info:doi/10.2196/33576 ER - TY - JOUR AU - Beukenhorst, L. Anna AU - Sergeant, C. Jamie AU - Schultz, M. David AU - McBeth, John AU - Yimer, B. Belay AU - Dixon, G. Will PY - 2021/11/16 TI - Understanding the Predictors of Missing Location Data to Inform Smartphone Study Design: Observational Study JO - JMIR Mhealth Uhealth SP - e28857 VL - 9 IS - 11 KW - geolocation KW - global positioning system KW - smartphones KW - mobile phone KW - mobile health KW - environmental exposures KW - data analysis KW - digital epidemiology KW - missing data KW - location data KW - mobile application N2 - Background: Smartphone location data can be used for observational health studies (to determine participant exposure or behavior) or to deliver a location-based health intervention. However, missing location data are more common when using smartphones compared to when using research-grade location trackers. Missing location data can affect study validity and intervention safety. Objective: The objective of this study was to investigate the distribution of missing location data and its predictors to inform design, analysis, and interpretation of future smartphone (observational and interventional) studies. Methods: We analyzed hourly smartphone location data collected from 9665 research participants on 488,400 participant days in a national smartphone study investigating the association between weather conditions and chronic pain in the United Kingdom. We used a generalized mixed-effects linear model with logistic regression to identify whether a successfully recorded geolocation was associated with the time of day, participants? time in study, operating system, time since previous survey completion, participant age, sex, and weather sensitivity. Results: For most participants, the app collected a median of 2 out of a maximum of 24 locations (1760/9665, 18.2% of participants), no location data (1664/9665, 17.2%), or complete location data (1575/9665, 16.3%). The median locations per day differed by the operating system: participants with an Android phone most often had complete data (a median of 24/24 locations) whereas iPhone users most often had a median of 2 out of 24 locations. The odds of a successfully recorded location for Android phones were 22.91 times higher than those for iPhones (95% CI 19.53-26.87). The odds of a successfully recorded location were lower during weekends (odds ratio [OR] 0.94, 95% CI 0.94-0.95) and nights (OR 0.37, 95% CI 0.37-0.38), if time in study was longer (OR 0.99 per additional day in study, 95% CI 0.99-1.00), and if a participant had not used the app recently (OR 0.96 per additional day since last survey entry, 95% CI 0.96-0.96). Participant age and sex did not predict missing location data. Conclusions: The predictors of missing location data reported in our study could inform app settings and user instructions for future smartphone (observational and interventional) studies. These predictors have implications for analysis methods to deal with missing location data, such as imputation of missing values or case-only analysis. Health studies using smartphones for data collection should assess context-specific consequences of high missing data, especially among iPhone users, during the night and for disengaged participants. UR - https://mhealth.jmir.org/2021/11/e28857 UR - http://dx.doi.org/10.2196/28857 UR - http://www.ncbi.nlm.nih.gov/pubmed/34783661 ID - info:doi/10.2196/28857 ER - TY - JOUR AU - Joshi, Megha AU - Shah, Aangi AU - Trivedi, Bhavi AU - Trivedi, Jaahnavee AU - Patel, Viral AU - Parghi, Devam AU - Thakkar, Manini AU - Barot, Kanan AU - Jadawala, Vivek PY - 2021/11/5 TI - Psychosocial and Behavioral Effects of the COVID-19 Pandemic in the Indian Population: Protocol for a Cross-sectional Study JO - JMIR Res Protoc SP - e29896 VL - 10 IS - 11 KW - COVID-19 KW - mental health KW - India KW - lockdown KW - isolation KW - social isolation KW - behavior KW - psychology KW - psychosocial effects N2 - Background: During the year 2020, the COVID-19 pandemic spread from China to the rest of the world, which prompted the world to implement a widespread mandated quarantine or social isolation. The impending uncertainty of the pandemic must have resulted in a variety of widespread mental health maladies. There has been documentation in the literature about a lot of these in small populations of the world but limited studies have been conducted in India, leading to limited evidence in the literature. Objective: The main objective of our study is to investigate the mental health effects that the COVID-19 pandemic has had on the general population in India both quantitatively and qualitatively. These results will help contribute to reducing the knowledge gap that is recognized in the literature, which is the result of the unprecedented and novel nature of the pandemic. Methods: We designed and validated our own questionnaire and used the method of circulating the questionnaire via WhatsApp (Facebook Inc). WhatsApp is a social media app that is very popularly used in India; hence, it turned out to be an effective medium for gathering pilot data. We analyzed the pilot data and used them to validate the questionnaire. This was done with the expertise of our mentor, Nilima Shah, MD (psychiatry). We gathered pilot data on 545 subjects and used the results to determine the changes that were needed for the questionnaire while simultaneously validating the questionnaire. Results: The study protocol was approved in September 2020 by the institutional review board at Vadilal Sarabhai General Hospital, Ahmedabad, Gujarat, India. Conclusions: The following preliminary assumptions can be made about the study based on the pilot data: the majority of the survey respondents were male (289/545, 53%), most of them were educated and employed as health care workers (199/545, 36.5%). The majority of the responders were self-employed (185/545, 33.9%), single (297/545, 54.5%), and stayed with their families (427/541, 79%) for the lockdown, which helped them psychologically. Findings that are specific to mental health have been elaborated upon in the manuscript. It is evident from the data collected in previous literature that the pandemic has had significant detrimental effects on the mental health of a vast proportion of the Indian population. International Registered Report Identifier (IRRID): DERR1-10.2196/29896 UR - https://www.researchprotocols.org/2021/11/e29896 UR - http://dx.doi.org/10.2196/29896 UR - http://www.ncbi.nlm.nih.gov/pubmed/34519652 ID - info:doi/10.2196/29896 ER - TY - JOUR AU - Milton, Alyssa AU - Hambleton, Ashlea AU - Roberts, Anna AU - Davenport, Tracey AU - Flego, Anna AU - Burns, Jane AU - Hickie, Ian PY - 2021/11/4 TI - Body Image Distress and Its Associations From an International Sample of Men and Women Across the Adult Life Span: Web-Based Survey Study JO - JMIR Form Res SP - e25329 VL - 5 IS - 11 KW - body image KW - mental health KW - well-being KW - web-based survey KW - sex differences KW - age N2 - Background: Previous research on body image distress mainly relied on samples that were small, generally homogeneous in age or sex, often limited to one geographical region, and were characterized by a lack of comprehensive analysis of multiple psychosocial domains. The research presented in this paper extends the international literature using the results of the web-based Global Health and Wellbeing Survey 2015. The survey included a large sample of both men and women aged ?16 years from Australia, Canada, New Zealand, the United Kingdom, or the United States. Objective: The main objectives of this study are to examine body image distress across the adult life span (?16 years) and sex and assess the association between body image distress and various psychosocial risk and protective factors. Methods: Data were extracted from the Global Health and Wellbeing Survey 2015, a web-based international self-report survey with 10,765 respondents, and compared with previous web-based surveys conducted in 2009 and 2012. Results: The body image distress of young Australians (aged 16-25 years) significantly rose by 33% from 2009 to 2015. In 2015, 75.19% (961/1278) of 16- to 25-year-old adults reported body image distress worldwide, and a decline in body image distress was noted with increasing age. More women reported higher levels of body image distress than men (1953/3338, 58.51% vs 853/2175, 39.22%). Sex, age, current dieting status, perception of weight, psychological distress, alcohol and other substance misuse, and well-being significantly explained 24% of the variance in body image distress in a linear regression (F15,4966=105.8; P<.001). Conclusions: This study demonstrates the significant interplay between body image distress and psychosocial factors across age and sex. UR - https://formative.jmir.org/2021/11/e25329 UR - http://dx.doi.org/10.2196/25329 UR - http://www.ncbi.nlm.nih.gov/pubmed/34734831 ID - info:doi/10.2196/25329 ER - TY - JOUR AU - Weber, M. Griffin AU - Zhang, G. Harrison AU - L'Yi, Sehi AU - Bonzel, Clara-Lea AU - Hong, Chuan AU - Avillach, Paul AU - Gutiérrez-Sacristán, Alba AU - Palmer, P. Nathan AU - Tan, Min Amelia Li AU - Wang, Xuan AU - Yuan, William AU - Gehlenborg, Nils AU - Alloni, Anna AU - Amendola, F. Danilo AU - Bellasi, Antonio AU - Bellazzi, Riccardo AU - Beraghi, Michele AU - Bucalo, Mauro AU - Chiovato, Luca AU - Cho, Kelly AU - Dagliati, Arianna AU - Estiri, Hossein AU - Follett, W. Robert AU - García Barrio, Noelia AU - Hanauer, A. David AU - Henderson, W. Darren AU - Ho, Yuk-Lam AU - Holmes, H. John AU - Hutch, R. Meghan AU - Kavuluru, Ramakanth AU - Kirchoff, Katie AU - Klann, G. Jeffrey AU - Krishnamurthy, K. Ashok AU - Le, T. Trang AU - Liu, Molei AU - Loh, Will Ne Hooi AU - Lozano-Zahonero, Sara AU - Luo, Yuan AU - Maidlow, Sarah AU - Makoudjou, Adeline AU - Malovini, Alberto AU - Martins, Roberto Marcelo AU - Moal, Bertrand AU - Morris, Michele AU - Mowery, L. Danielle AU - Murphy, N. Shawn AU - Neuraz, Antoine AU - Ngiam, Yuan Kee AU - Okoshi, P. Marina AU - Omenn, S. Gilbert AU - Patel, P. Lav AU - Pedrera Jiménez, Miguel AU - Prudente, A. Robson AU - Samayamuthu, Jebathilagam Malarkodi AU - Sanz Vidorreta, J. Fernando AU - Schriver, R. Emily AU - Schubert, Petra AU - Serrano Balazote, Pablo AU - Tan, WL Byorn AU - Tanni, E. Suzana AU - Tibollo, Valentina AU - Visweswaran, Shyam AU - Wagholikar, B. Kavishwar AU - Xia, Zongqi AU - Zöller, Daniela AU - AU - Kohane, S. Isaac AU - Cai, Tianxi AU - South, M. Andrew AU - Brat, A. Gabriel PY - 2021/10/11 TI - International Changes in COVID-19 Clinical Trajectories Across 315 Hospitals and 6 Countries: Retrospective Cohort Study JO - J Med Internet Res SP - e31400 VL - 23 IS - 10 KW - SARS-CoV-2 KW - electronic health records KW - federated study KW - retrospective cohort study KW - meta-analysis KW - COVID-19 KW - severe COVID-19 KW - laboratory trajectory N2 - Background: Many countries have experienced 2 predominant waves of COVID-19?related hospitalizations. Comparing the clinical trajectories of patients hospitalized in separate waves of the pandemic enables further understanding of the evolving epidemiology, pathophysiology, and health care dynamics of the COVID-19 pandemic. Objective: In this retrospective cohort study, we analyzed electronic health record (EHR) data from patients with SARS-CoV-2 infections hospitalized in participating health care systems representing 315 hospitals across 6 countries. We compared hospitalization rates, severe COVID-19 risk, and mean laboratory values between patients hospitalized during the first and second waves of the pandemic. Methods: Using a federated approach, each participating health care system extracted patient-level clinical data on their first and second wave cohorts and submitted aggregated data to the central site. Data quality control steps were adopted at the central site to correct for implausible values and harmonize units. Statistical analyses were performed by computing individual health care system effect sizes and synthesizing these using random effect meta-analyses to account for heterogeneity. We focused the laboratory analysis on C-reactive protein (CRP), ferritin, fibrinogen, procalcitonin, D-dimer, and creatinine based on their reported associations with severe COVID-19. Results: Data were available for 79,613 patients, of which 32,467 were hospitalized in the first wave and 47,146 in the second wave. The prevalence of male patients and patients aged 50 to 69 years decreased significantly between the first and second waves. Patients hospitalized in the second wave had a 9.9% reduction in the risk of severe COVID-19 compared to patients hospitalized in the first wave (95% CI 8.5%-11.3%). Demographic subgroup analyses indicated that patients aged 26 to 49 years and 50 to 69 years; male and female patients; and black patients had significantly lower risk for severe disease in the second wave than in the first wave. At admission, the mean values of CRP were significantly lower in the second wave than in the first wave. On the seventh hospital day, the mean values of CRP, ferritin, fibrinogen, and procalcitonin were significantly lower in the second wave than in the first wave. In general, countries exhibited variable changes in laboratory testing rates from the first to the second wave. At admission, there was a significantly higher testing rate for D-dimer in France, Germany, and Spain. Conclusions: Patients hospitalized in the second wave were at significantly lower risk for severe COVID-19. This corresponded to mean laboratory values in the second wave that were more likely to be in typical physiological ranges on the seventh hospital day compared to the first wave. Our federated approach demonstrated the feasibility and power of harmonizing heterogeneous EHR data from multiple international health care systems to rapidly conduct large-scale studies to characterize how COVID-19 clinical trajectories evolve. UR - https://www.jmir.org/2021/10/e31400 UR - http://dx.doi.org/10.2196/31400 UR - http://www.ncbi.nlm.nih.gov/pubmed/34533459 ID - info:doi/10.2196/31400 ER - TY - JOUR AU - Pinilla, T. Yudi AU - Friessinger, Evelyn AU - Griesbaum, Marie Johanna AU - Berner, Lilith AU - Heinzel, Constanze AU - Elsner, Käthe AU - Fendel, Rolf AU - Held, Jana AU - Kreidenweiss, Andrea PY - 2021/10/8 TI - Prevalence of SARS-CoV-2 Infection in Children by Antibody Detection in Saliva: Protocol for a Prospective Longitudinal Study (Coro-Buddy) JO - JMIR Res Protoc SP - e27739 VL - 10 IS - 10 KW - SARS-CoV-2 KW - COVID-19 KW - antibody KW - saliva KW - children KW - epidemiology N2 - Background: The world has been confronted with the COVID-19 pandemic for more than one year. Severe disease is more often found among elderly people, whereas most young children and adolescents show mild symptoms or even remain asymptomatic, so that infection might be undiagnosed. Therefore, only limited epidemiological data on SARS-CoV-2 infection in children and young adults are available. Objective: This study aims to determine the prevalence of SARS-CoV-2 antibodies in children from the city of Tübingen, Germany, and to measure the incidence of new cases over 12 months. Methods: SARS-CoV-2 antibodies will be measured in saliva as a surrogate for a previous SARS-CoV-2 infection. Children will be sampled at their preschools, primary schools, and secondary schools at three time points: July 2020, October to December 2020, and April to July 2021. An adult cohort will be sampled at the same time points (ie, adult comparator group). The saliva-based SARS-CoV-2?antibody enzyme-linked immunosorbent assay will be validated using blood and saliva samples from adults with confirmed previous SARS-CoV-2 infections (ie, adult validation group). Results: The first study participant was enrolled in July 2020, and recruitment and enrollment continued until July 2021. We have recruited and enrolled 1850 children, 560 adults for the comparator group, and 83 adults for the validation group. We have collected samples from the children and the adults for the comparator group at the three time points. We followed up with participants in the adult validation group every 2 months and, as of the writing of this paper, we were at time point 7. We will conduct data analysis after the data collection period. Conclusions: Infection rates in children are commonly underreported due to a lack of polymerase chain reaction testing. This study will report on the prevalence of SARS-CoV-2 infections in infants, school children, and adolescents as well as the incidence change over 12 months in the city of Tübingen, Germany. The saliva sampling approach for SARS-CoV-2?antibody measurement allows for a unique, representative, population-based sample collection process. Trial Registration: ClinicalTrials.gov NCT04581889; https://clinicaltrials.gov/ct2/show/NCT04581889 International Registered Report Identifier (IRRID): DERR1-10.2196/27739 UR - https://www.researchprotocols.org/2021/10/e27739 UR - http://dx.doi.org/10.2196/27739 UR - http://www.ncbi.nlm.nih.gov/pubmed/34533472 ID - info:doi/10.2196/27739 ER - TY - JOUR AU - De Ridder, David AU - Loizeau, Jutta Andrea AU - Sandoval, Luis José AU - Ehrler, Frédéric AU - Perrier, Myriam AU - Ritch, Albert AU - Violot, Guillemette AU - Santolini, Marc AU - Greshake Tzovaras, Bastian AU - Stringhini, Silvia AU - Kaiser, Laurent AU - Pradeau, Jean-François AU - Joost, Stéphane AU - Guessous, Idris PY - 2021/10/6 TI - Detection of Spatiotemporal Clusters of COVID-19?Associated Symptoms and Prevention Using a Participatory Surveillance App: Protocol for the @choum Study JO - JMIR Res Protoc SP - e30444 VL - 10 IS - 10 KW - participatory surveillance KW - infectious disease KW - COVID-19 KW - SARS-CoV-2 KW - space-time clustering KW - digital health KW - mobile app KW - mHealth KW - epidemiology KW - surveillance KW - digital surveillance KW - public health N2 - Background: The early detection of clusters of infectious diseases such as the SARS-CoV-2?related COVID-19 disease can promote timely testing recommendation compliance and help to prevent disease outbreaks. Prior research revealed the potential of COVID-19 participatory syndromic surveillance systems to complement traditional surveillance systems. However, most existing systems did not integrate geographic information at a local scale, which could improve the management of the SARS-CoV-2 pandemic. Objective: The aim of this study is to detect active and emerging spatiotemporal clusters of COVID-19?associated symptoms, and to examine (a posteriori) the association between the clusters? characteristics and sociodemographic and environmental determinants. Methods: This report presents the methodology and development of the @choum (English: ?achoo?) study, evaluating an epidemiological digital surveillance tool to detect and prevent clusters of individuals (target sample size, N=5000), aged 18 years or above, with COVID-19?associated symptoms living and/or working in the canton of Geneva, Switzerland. The tool is a 5-minute survey integrated into a free and secure mobile app (CoronApp-HUG). Participants are enrolled through a comprehensive communication campaign conducted throughout the 12-month data collection phase. Participants register to the tool by providing electronic informed consent and nonsensitive information (gender, age, geographically masked addresses). Symptomatic participants can then report COVID-19?associated symptoms at their onset (eg, symptoms type, test date) by tapping on the @choum button. Those who have not yet been tested are offered the possibility to be informed on their cluster status (information returned by daily automated clustering analysis). At each participation step, participants are redirected to the official COVID-19 recommendations websites. Geospatial clustering analyses are performed using the modified space-time density-based spatial clustering of applications with noise (MST-DBSCAN) algorithm. Results: The study began on September 1, 2020, and will be completed on February 28, 2022. Multiple tests performed at various time points throughout the 5-month preparation phase have helped to improve the tool?s user experience and the accuracy of the clustering analyses. A 1-month pilot study performed among 38 pharmacists working in 7 Geneva-based pharmacies confirmed the proper functioning of the tool. Since the tool?s launch to the entire population of Geneva on February 11, 2021, data are being collected and clusters are being carefully monitored. The primary study outcomes are expected to be published in mid-2022. Conclusions: The @choum study evaluates an innovative participatory epidemiological digital surveillance tool to detect and prevent clusters of COVID-19?associated symptoms. @choum collects precise geographic information while protecting the user?s privacy by using geomasking methods. By providing an evidence base to inform citizens and local authorities on areas potentially facing a high COVID-19 burden, the tool supports the targeted allocation of public health resources and promotes testing. International Registered Report Identifier (IRRID): DERR1-10.2196/30444 UR - https://www.researchprotocols.org/2021/10/e30444 UR - http://dx.doi.org/10.2196/30444 UR - http://www.ncbi.nlm.nih.gov/pubmed/34449403 ID - info:doi/10.2196/30444 ER - TY - JOUR AU - Lillie, Tiffany AU - Boyee, Dorica AU - Kamariza, Gloriose AU - Nkunzimana, Alphonse AU - Gashobotse, Dismas AU - Persaud, Navindra PY - 2021/9/30 TI - Increasing Testing Options for Key Populations in Burundi Through Peer-Assisted HIV Self-Testing: Descriptive Analysis of Routine Programmatic Data JO - JMIR Public Health Surveill SP - e24272 VL - 7 IS - 9 KW - HIV KW - HIV self-testing KW - key populations KW - case finding KW - ART initiation KW - Burundi N2 - Background: In Burundi, given the low testing numbers among key populations (KPs), peer-assisted HIV self-testing (HIVST) was initiated for female sex workers (FSWs), men who have sex with men (MSM), and transgender people to provide another testing option. HIVST was provided by existing peer outreach workers who were trained to provide support before, during, and after the administration of the test. People who screened reactive were referred and actively linked to confirmatory testing, and those confirmed positive were linked to treatment. Standard testing included HIV testing by clinical staff either at mobile clinics in the community or in facilities. Objective: This study aims to improve access to HIV testing for underserved KPs, improve diagnoses of HIV serostatus among key populations, and link those who were confirmed HIV positive to life-saving treatment for epidemic control. Methods: A descriptive analysis was conducted using routine programmatic data that were collected during a 9-month implementation period (June 2018 to March 2019) for peer-assisted HIVST among FSWs, MSM, and transgender people in 6 provinces where the US Agency for International Development?and US President?s Emergency Plan for AIDS Relief?funded LINKAGES (Linkage across the Continuum of HIV Services for KP Affected by HIV) Burundi project was being implemented. Chi-square tests were used to compare case-finding rates among individuals who were tested through HIVST versus standard testing. Multivariable logistic regression was performed to assess factors that were independently associated with HIV seropositivity among FSWs and MSM who used HIVST kits. Results: A total of 2198 HIVST kits were administered (FSWs: 1791/2198, 81.48%; MSM: 363/2198, 16.52%; transgender people: 44/2198, 2%). HIV seropositivity rates from HIVST were significantly higher than those from standard testing for FSWs and MEM and nonsignificantly higher than those from standard testing for transgender people (FSWs: 257/1791, 14.35% vs 890/9609, 9.26%; P<.001; MSM: 47/363, 12.95% vs 90/2431, 3.7%; P<.001; transgender people: 10/44, 23% vs 6/36, 17%; P=.50). Antiretroviral therapy initiation rates were significantly lower among MSM who were confirmed to be HIV positive through HIVST compared to those among MSM who were confirmed to be HIV positive through standard testing (40/47, 85% vs 89/90, 99%; P<.001). No significant differences in antiretroviral therapy initiation rates were found between the FSW and transgender groups. Multivariable analyses among FSWs who used HIVST kits showed that being aged ?25 years (adjusted odds ratio 1.9, 95% CI 1.4-2.6) and having >8 clients per week (adjusted odds ratio 1.3, 95% CI 1.0-1.8) were independently associated with HIV seropositivity. Conclusions: The results demonstrate the potential effectiveness of HIVST in newly diagnosing underserved KPs and linking them to treatment. UR - https://publichealth.jmir.org/2021/9/e24272 UR - http://dx.doi.org/10.2196/24272 UR - http://www.ncbi.nlm.nih.gov/pubmed/34591018 ID - info:doi/10.2196/24272 ER - TY - JOUR AU - Perez-Ramos, G. Jose AU - McIntosh, Scott AU - Barrett, S. Emily AU - Velez Vega, M. Carmen AU - Dye, D. Timothy PY - 2021/9/23 TI - Attitudes Toward the Environment and Use of Information and Communication Technologies to Address Environmental Health Risks in Marginalized Communities: Prospective Cohort Study JO - J Med Internet Res SP - e24671 VL - 23 IS - 9 KW - community engagement KW - environmental health risk KW - epidemiology KW - ICT KW - mHealth KW - mobile phone KW - Puerto Rico N2 - Background: Information and communication technologies, including mobile health (mHealth), can help isolated communities address environmental health challenges. The Puerto Rican island of Culebra has faced multiple sociopolitical and economic factors that have distressed the island?s environment and health. Culebrenses are technologically engaged and have demonstrated a use of technology that transcends socioeconomic barriers. As a result, technological interventions could potentially help manage environmental risks on the island. Objective: This study aims to test and evaluate the potential benefits of an mHealth tool, termed ¡mZAP! (Zonas, Acción y Protección), for engaging communities with environmental risks through technology. Methods: Participants using ¡mZAP! (N=111) were surveyed. Bivariate analyses were used to examine associations of mHealth use with sociodemographics, technology use, an adapted environmental attitudes inventory, and the multidimensional health locus of control. Logistic regression was used to examine associations between attitudes toward environmental health risks and mHealth use. Results: Higher positive attitudes toward the environment were significantly associated with the use of ¡mZAP! (odds ratio 5.3, 95% CI 1.6-17.0). Environmental attitudes were also associated with the multidimensional health locus of control powerful others subscale (P=.02), indicating that attitudes toward the environment become more negative as feelings controlled by others increase. Participants felt that the authorities would resolve the challenges (63/111, 56.7%). Conclusions: Perceived lack of control could present barriers to collective actions to address salient environmental health challenges in communities. The ongoing dependency on government-based solutions to community problems is worrisome, especially after the hurricane experiences of 2017 (which may potentially continue to be an issue subsequent to the more recent 2020 earthquakes). UR - https://www.jmir.org/2021/9/e24671 UR - http://dx.doi.org/10.2196/24671 UR - http://www.ncbi.nlm.nih.gov/pubmed/34554103 ID - info:doi/10.2196/24671 ER - TY - JOUR AU - Reid, Holly AU - Miller, Cameron William AU - Esfandiari, Elham AU - Mohammadi, Somayyeh AU - Rash, Isabelle AU - Tao, Gordon AU - Simpson, Ethan AU - Leong, Kai AU - Matharu, Parmeet AU - Sakakibara, Brodie AU - Schmidt, Julia AU - Jarus, Tal AU - Forwell, Susan AU - Borisoff, Jaimie AU - Backman, Catherine AU - Alic, Adam AU - Brooks, Emily AU - Chan, Janice AU - Flockhart, Elliott AU - Irish, Jessica AU - Tsukura, Chihori AU - Di Spirito, Nicole AU - Mortenson, Ben William PY - 2021/9/1 TI - The Impact of COVID-19?Related Restrictions on Social and Daily Activities of Parents, People With Disabilities, and Older Adults: Protocol for a Longitudinal, Mixed Methods Study JO - JMIR Res Protoc SP - e28337 VL - 10 IS - 9 KW - COVID-19 KW - longitudinal study KW - spinal cord injury KW - disability KW - adult KW - occupational disruption KW - stroke KW - older adults N2 - Background: The COVID-19 pandemic has led to wide-scale changes in societal organization. This has dramatically altered people?s daily activities, especially among families with young children, those living with disabilities such as spinal cord injury (SCI), those who have experienced a stroke, and older adults. Objective: We aim to (1) investigate how COVID-19 restrictions influence daily activities, (2) track the psychosocial effects of these restrictions over time, and (3) identify strategies to mitigate the potential negative effects of these restrictions. Methods: This is a longitudinal, concurrent, mixed methods study being conducted in British Columbia (BC), Canada. Data collection occurred at four time points, between April 2020 and February 2021. The first three data collection time points occurred within phases 1 to 3 of the Province of BC?s Restart Plan. The final data collection coincided with the initial distribution of the COVID-19 vaccines. At each time point, data regarding participants? sociodemographics, depressive and anxiety symptoms, resilience, boredom, social support, instrumental activities of daily living, and social media and technology use were collected in an online survey. These data supplemented qualitative videoconference interviews exploring participants? COVID-19?related experiences. Participants were also asked to upload photos representing their experience during the restriction period, which facilitated discussion during the final interview. Five groups of participants were recruited: (1) families with children under the age of 18 years, (2) adults with an SCI, (3) adults who experienced a stroke, (4) adults with other types of disabilities, and (5) older adults (>64 years of age) with no self-reported disability. The number of participants we could recruit from each group was limited, which may impact the validity of some subgroup analyses. Results: This study was approved by the University of British Columbia Behavioural Research Ethics Board (Approval No. H20-01109) on April 17, 2020. A total of 81 participants were enrolled in this study and data are being analyzed. Data analyses are expected to be completed in fall 2021; submission of multiple papers for publication is expected by winter 2021. Conclusions: Findings from our study will inform the development and recommendations of a new resource guide for the post?COVID-19 period and for future public health emergencies. International Registered Report Identifier (IRRID): DERR1-10.2196/28337 UR - https://www.researchprotocols.org/2021/9/e28337 UR - http://dx.doi.org/10.2196/28337 UR - http://www.ncbi.nlm.nih.gov/pubmed/34292163 ID - info:doi/10.2196/28337 ER - TY - JOUR AU - Alsafadi, Danyah AU - Ezzat, Aly AU - Altamimi, Fatima AU - ElBagoury, Marwan AU - Olfat, Mohammed AU - Saleh, Mohammed AU - Roushdy, Sherif AU - Aktham, Yahia PY - 2021/8/31 TI - Mucopolysaccharidosis Type I Disease Prevalence Among Patients With Idiopathic Short Stature in Saudi Arabia: Protocol for a Multicenter Cross-sectional Study JO - JMIR Res Protoc SP - e28619 VL - 10 IS - 8 KW - mucopolysaccharidosis KW - lysosomal storage disorders KW - epidemiology KW - Saudi Arabia N2 - Background: Since the underlying cause of idiopathic short stature can indeed be undiagnosed mucopolysaccharidosis type I, it is critical to identify patients with mucopolysaccharidosis type I among screened patients with idiopathic short stature. Objective: The primary objective of this study is to determine the prevalence of mucopolysaccharidosis type I disease in a high-risk group (ie, patients with idiopathic short stature). Methods: We plan to perform a multicenter, cross-sectional screening study to primarily assess the prevalence of mucopolysaccharidosis type I disease in patients with idiopathic short stature. All eligible patients will be tested after obtaining written informed consent from their parents and guardians. Eligible patients will be recruited over 18 months from specialty care centers for pediatrics and genetics. Results: This protocol was approved by the Institutional Review Board of King Fahd Medical City and funded by Sanofi Genzyme Saudi Arabia. We expect to collect data from ?800 patients, as determined by our sample size calculation. Conclusions: Saudi Arabia is the largest country in the Arabian Peninsula; it has a population of more than 28 million people. To date, there are no reliable data regarding the incidence and prevalence of mucopolysaccharidosis type I in Saudi Arabia; therefore, future multicenter studies will be needed. Further, the prevalence of an attenuated form of mucopolysaccharidosis type I is largely underestimated in Saudi Arabia due to the absence of an effective newborn screening program. Therefore, the implementation of a nationwide newborn screening program is essential for the accurate estimation of the burden of mucopolysaccharidosis and the early diagnosis of patients. International Registered Report Identifier (IRRID): PRR1-10.2196/28619 UR - https://www.researchprotocols.org/2021/8/e28619 UR - http://dx.doi.org/10.2196/28619 UR - http://www.ncbi.nlm.nih.gov/pubmed/34463634 ID - info:doi/10.2196/28619 ER - TY - JOUR AU - Linden, Brooke PY - 2021/8/31 TI - Cross-Canada Release of the Post-Secondary Student Stressors Index (PSSI): Protocol for a Cross-sectional, Repeated Measures Study JO - JMIR Res Protoc SP - e27713 VL - 10 IS - 8 KW - stress KW - mental health KW - health promotion KW - postsecondary KW - higher education KW - measurement tool KW - study protocol N2 - Background: The prevalence of mental health?related problems, including stress, psychological distress, and symptoms of mental illnesses, continues to increase among Canadian postsecondary student populations. Excessive stress in this population has been linked to a number of negative academic and health outcomes. Despite attempts to improve mental health at postsecondary institutions, a persistent gap exists in the evaluation of the specific sources of stress for students within the postsecondary setting. Objective: The purpose of this paper is to report the study protocol for a cross-Canada, multisite launch of the Post-Secondary Student Stressors Index (PSSI), which will engage postsecondary institutions across the country as partners and facilitate improved measurement of the sources of student stress, in addition to contributing toward improved tailoring of upstream mental health services and support. Methods: Created in collaboration with students, the PSSI is a validated 46-item tool assessing stressors across five domains: academics, learning environment, campus culture, interpersonal, and personal stressors. The tool is designed to be applicable to students at all years, levels, and areas of study. Data will be collected longitudinally at multiple time points over the course of each academic year. Results: We recruited 15 postsecondary institutions across Canada for the first year, inviting students to participate in an online survey including questions concerning sociodemographic characteristics, stress, mental health, and resiliency. Analyses, including appropriate data visualization, will be conducted to determine the impact of specific stressors on mental health, linking responses over time to allow for the observation of changes in trends. Conclusions: The PSSI is an intuitive and evidence-informed tool that can aid postsecondary institutions in evaluating the sources of student stress on their campuses. This multisite project will make a substantial contribution to the current literature regarding postsecondary student stress and allow institutions across the country to improve the tailoring of upstream mental health services in order to directly support the unique needs of their student body. Opportunities for knowledge translation and exchange are discussed. International Registered Report Identifier (IRRID): DERR1-10.2196/27713 UR - https://www.researchprotocols.org/2021/8/e27713 UR - http://dx.doi.org/10.2196/27713 UR - http://www.ncbi.nlm.nih.gov/pubmed/34463632 ID - info:doi/10.2196/27713 ER - TY - JOUR AU - Ganie, Ashraf Mohd AU - Chowdhury, Subhankar AU - Suri, Vanita AU - Joshi, Beena AU - Bhattacharya, Kumar Prasanta AU - Agrawal, Sarita AU - Malhotra, Neena AU - Sahay, Rakesh AU - Rozati, Roya AU - Jabbar, Khadar Puthiyaveettil AU - Sreenivas, Vishnubhatla AU - Sriwastva, Mukesh AU - Wani, Ahmad Imtiyaz AU - Singh, Shalini AU - Sharma, Shyam Radhey PY - 2021/8/27 TI - 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 JO - JMIR Res Protoc SP - e23437 VL - 10 IS - 8 KW - polycystic ovary syndrome KW - prevalence KW - metabolic aberrations KW - community pool KW - therapeutic modalities KW - India KW - metabolic dysfunction KW - phenotypic variations KW - ovarian morphology KW - PCOS epidemiology N2 - 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 UR - https://www.researchprotocols.org/2021/8/e23437 UR - http://dx.doi.org/10.2196/23437 UR - http://www.ncbi.nlm.nih.gov/pubmed/34448720 ID - info:doi/10.2196/23437 ER - TY - JOUR AU - Katayama, Yusuke AU - Kiyohara, Kosuke AU - Hirose, Tomoya AU - Matsuyama, Tasuku AU - Ishida, Kenichiro AU - Nakao, Shunichiro AU - Tachino, Jotaro AU - Ojima, Masahiro AU - Noda, Tomohiro AU - Kiguchi, Takeyuki AU - Hayashida, Sumito AU - Kitamura, Tetsuhisa AU - Mizobata, Yasumitsu AU - Shimazu, Takeshi PY - 2021/6/30 TI - A Mobile App for Self-Triage for Pediatric Emergency Patients in Japan: 4 Year Descriptive Epidemiological Study JO - JMIR Pediatr Parent SP - e27581 VL - 4 IS - 2 KW - emergency medicine KW - self-triage KW - mobile app KW - children KW - telemedicine KW - app KW - mobile health KW - mHealth KW - epidemiology N2 - Background: When children suffer sudden illness or injury, many parents wonder whether they should go to the hospital immediately or call an ambulance. In 2015, we developed a mobile app that allows parents or guardians to determine the urgency of their child?s condition or call an ambulance and that indicates available hospitals and clinics when their child is suddenly sick or injured by simple selection of the child?s chief complaints and symptoms. However, the effectiveness of medical apps used by the general public has not been well evaluated. Objective: The purpose of this study was to clarify the use profile of this mobile app based on data usage in the app. Methods: This study was a descriptive epidemiological study with a 4-year study period running from January 2016 to December 2019. We included cases in which the app was used either by the children themselves or by their parents and other guardians. Cases in which the app was downloaded but never actually used were excluded from this study. Continuous variables are presented as median and IQR, and categorical variables are presented as actual number and percentages. Results: The app was used during the study period for 59,375 children whose median age was 1 year (IQR 0-3 years). The app was used for 33,874 (57.05%) infants, 16,228 (27.33%) toddlers, 8102 (13.65%) elementary school students, and 1117 (1.88%) junior high school students, with 54 (0.09%) having an unknown status. Furthermore, 31,519 (53.08%) were male and 27,329 (46.03%) were female, with sex being unknown for 527 (0.89%) children. ?Sickness? was chosen for 49,101 (78.51%) patients, and ?injury, poisoning, foreign, substances and others? was chosen for 13,441 (21.49%). For ?sickness,? ?fever? was the most commonly selected option (22,773, 36.41%), followed by ?cough? (4054, 6.48%), and ?nausea/vomiting? (3528, 5.64%), whereas for ?injury, poisoning, foreign substances and others,? ?head and neck injury? was the most commonly selected option (3887, 6.22%), followed by ?face and extremities injury? (1493, 2.39%) and ?injury and foreign substances in eyes? (1255, 2.01%). Conclusions: This study clarified the profile of use of a self-triage app for pediatric emergency patients in Japan. UR - https://pediatrics.jmir.org/2021/2/e27581 UR - http://dx.doi.org/10.2196/27581 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255709 ID - info:doi/10.2196/27581 ER - TY - JOUR AU - Krej?í, Denisa AU - Karolyi, Mat?j AU - Pehalová, Lucie AU - ??avnický, Jakub AU - Zapletalová, Michaela AU - Katinová, Ivana AU - ?t?rba, Jaroslav AU - Starý, Jan AU - ?najdrová, Lenka AU - Komenda, Martin AU - Du?ek, Ladislav PY - 2021/6/29 TI - Development of the Czech Childhood Cancer Information System: Data Analysis and Interactive Visualization JO - JMIR Public Health Surveill SP - e23990 VL - 7 IS - 6 KW - cancer epidemiology KW - children KW - data visualization KW - software development N2 - Background: The knowledge of cancer burden in the population, its time trends, and the possibility of international comparison is an important starting point for cancer programs. A reliable interactive tool describing cancer epidemiology in children and adolescents has been nonexistent in the Czech Republic until recently. Objective: The goal of this study is to develop a new web portal entitled the Czech Childhood Cancer Information System (CCCIS), which would provide information on childhood cancer epidemiology in the Czech Republic. Methods: Data on childhood cancers have been obtained from the Czech National Cancer Registry. These data were validated using the clinical database of childhood cancer patients and subsequently combined with data from the National Register of Hospitalised Patients and with data from death certificates. These validated data were then used to determine the incidence and survival rates of childhood cancer patients aged 0 to 19 years who were diagnosed in the period 1994 to 2016 (N=9435). Data from death certificates were used to monitor long-term mortality trends. The technical solution is based on the robust PHP development Symfony framework, with the PostgreSQL system used to accommodate the data basis. Results: The web portal has been available for anyone since November 2019, providing basic information for experts (ie, analyses and publications) on individual diagnostic groups of childhood cancers. It involves an interactive tool for analytical reporting, which provides information on the following basic topics in the form of graphs or tables: incidence, mortality, and overall survival. Feedback was obtained and the accuracy of outputs published on the CCCIS portal was verified using the following methods: the validation of the theoretical background and the user testing. Conclusions: We developed software capable of processing data from multiple sources, which is freely available to all users and makes it possible to carry out automated analyses even for users without mathematical background; a simple selection of a topic to be analyzed is required from the user. UR - https://publichealth.jmir.org/2021/6/e23990 UR - http://dx.doi.org/10.2196/23990 UR - http://www.ncbi.nlm.nih.gov/pubmed/34185010 ID - info:doi/10.2196/23990 ER - TY - JOUR AU - Lutrick, Karen AU - Ellingson, D. Katherine AU - Baccam, Zoe AU - Rivers, Patrick AU - Beitel, Shawn AU - Parker, Joel AU - Hollister, James AU - Sun, Xiaoxiao AU - Gerald, K. Joe AU - Komatsu, Kenneth AU - Kim, Elizabeth AU - LaFleur, Bonnie AU - Grant, Lauren AU - Yoo, M. Young AU - Kumar, Archana AU - Mayo Lamberte, Julie AU - Cowling, J. Benjamin AU - Cobey, Sarah AU - Thornburg, J. Natalie AU - Meece, K. Jennifer AU - Kutty, Preeta AU - Nikolich-Zugich, Janko AU - Thompson, G. Mark AU - Burgess, L. Jefferey PY - 2021/6/24 TI - COVID-19 Infection, Reinfection, and Vaccine Effectiveness in Arizona Frontline and Essential Workers: Protocol for a Longitudinal Cohort Study JO - JMIR Res Protoc SP - e28925 VL - 10 IS - 6 KW - SARS-CoV-2 KW - COVID-19 KW - health care personnel KW - first responders KW - essential workers N2 - Background: COVID-19 has spread worldwide since late 2019, with an unprecedented case count and death toll globally. Health care personnel (HCP), first responders, and other essential and frontline workers (OEWs) are at increased risk of SARS-CoV-2 infection because of frequent close contact with others. Objective: The Arizona Healthcare, Emergency Response, and Other Essential Workers Study (AZ HEROES) aims to examine the epidemiology of SARS-CoV-2 infection and COVID-19 illness among adults with high occupational exposure risk. Study objectives include estimating the incidence of SARS-CoV-2 infection in essential workers by symptom presentation and demographic factors, determining independent effects of occupational and community exposures on incidence of SARS-CoV-2 infection, establishing molecular and immunologic characteristics of SARS-CoV-2 infection in essential workers, describing the duration and patterns of real-time reverse transcription?polymerase chain reaction (rRT-PCR) positivity, and examining postvaccine immunologic response. Methods: Eligible participants include Arizona residents aged 18 to 85 years who work at least 20 hours per week in an occupation involving regular direct contact (ie, within 3 feet) with others. Recruitment goals are stratified by demographic characteristics (50% aged 40 years or older, 50% women, and 50% Hispanic or American Indian), by occupation (40% HCP, 30% first responders, and 30% OEWs), and by prior SARS-CoV-2 infection (with up to 50% seropositive at baseline). Information on sociodemographics, health and medical history, vaccination status, exposures to individuals with suspected or confirmed SARS-CoV-2 infection, use of personal protective equipment, and perceived risks are collected at enrollment and updated through quarterly surveys. Every week, participants complete active surveillance for COVID-like illness (CLI) and self-collect nasal swabs. Additional self-collected nasal swab and saliva specimens are collected in the event of CLI onset. Respiratory specimens are sent to Marshfield Laboratories and tested for SARS-CoV-2 by rRT-PCR assay. CLI symptoms and impact on work and productivity are followed through illness resolution. Serum specimens are collected every 3 months and additional sera are collected following incident rRT-PCR positivity and after each COVID-19 vaccine dose. Incidence of SARS-CoV-2 infections will be calculated by person-weeks at risk and compared by occupation and demographic characteristics as well as by seropositivity status and infection and vaccination history. Results: The AZ HEROES study was funded by the US Centers for Disease Control and Prevention. Enrollment began on July 27, 2020; as of May 1, 2021, a total of 3165 participants have been enrolled in the study. Enrollment is expected to continue through December 1, 2021, with data collection continuing through at least April 2022, contingent upon funding. Conclusions: AZ HEROES is unique in aiming to recruit a diverse sample of essential workers and to prospectively follow strata of SARS-CoV-2 seronegative and seropositive adults. Survey results combined with active surveillance data on exposure, CLI, weekly molecular diagnostic testing, and periodic serology will be used to estimate the incidence of symptomatic and asymptomatic SARS-CoV-2 infection, assess the intensity and durability of immune responses to natural infection and COVID-19 vaccination, and contribute to the evaluation of COVID-19 vaccine effectiveness. International Registered Report Identifier (IRRID): DERR1-10.2196/28925 UR - https://www.researchprotocols.org/2021/6/e28925/ UR - http://dx.doi.org/10.2196/28925 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/28925 ER - TY - JOUR AU - Abdulmoghni, Taher Rihana AU - Al-Ward, Hasan Ahmed AU - Al-Moayed, Abdullah Khaled AU - AL-Amad, Abdullah Mohammed AU - Khader, S. Yousef PY - 2021/6/22 TI - Incidence, Trend, and Mortality of Human Exposure to Rabies in Yemen, 2011-2017: Observational Study JO - JMIR Public Health Surveill SP - e27623 VL - 7 IS - 6 KW - rabies KW - incidence KW - trend KW - mortality N2 - Background: Rabies remains a neglected and poorly controlled disease throughout the developing world, particularly in Africa and Asia, where most human rabies deaths occur. Objective: This study aimed to describe the epidemiology of rabies exposures, its trend, and its geographical distribution in Yemen. Methods: Cumulative data from a rabies surveillance system for the period 2011-2017 were obtained from the National Rabies Control Program as paper-based annual reports. Data included the number of persons bitten by a suspected rabid animal, their gender and age, and the result of the animal?s laboratory test. Human cases were defined as those exposed to rabies virus bitten by a suspected rabid animal, exposed to a confirmed rabid animal and then received postexposure prophylaxis (PEP), and deaths occurred after exposure to a confirmed rabid animal after having rabies symptoms during 2011-2017. Results: From 2011 to 2017, a total of 76,049 persons were bitten by a suspected rabid animal. Of these, 21,927 (28.83%) were exposed to positively confirmed rabid animals and then received PEP, and 295 (0.38%) rabies-related deaths occurred. Of all cases with rabies exposure, 50,882 (66.91%) were males. The most affected age group by animal bites (31,816/76,041, 41.84%), positive exposure (8945/21,927, 40.79%), and rabies deaths (143/295, 48.47%) was 5-14 years. Rabies vaccines and immunoglobulins quantities were least available in 2016 and 2017. The annual incidence rate of exposure to animal bites and rabies exposure was 50 and 14 per 100,000, respectively. The annual mortality rate was 2 per 1,000,000. The highest incidence rate of animal bites was in Dhamar (112 per 100,000) and Ibb (94 per 100,000), whereas the highest incidence of exposed cases was in Amanat Al Asimah (40 per 100,000) and Ibb (37 per 100,000). Mortality rate was the highest in Amanat Al Asimah (6 deaths per 1,000,000) followed by Ibb and Dhamar (4 deaths per 1,000,000 in both). Conclusions: Rabies remains a worrying health problem in Yemen with higher percentage reported among children and males. Targeting school-age populations by education, communication, and information campaigns about preventive measures is strongly recommended. An electronic system should be introduced to improve reporting. It is important to have a sufficient supply of vaccines and immunoglobulins in control units, especially in the at-risk or impacted governorates. Future studies are suggested to determine incidences and risk factors of disease progression. UR - https://publichealth.jmir.org/2021/6/e27623 UR - http://dx.doi.org/10.2196/27623 UR - http://www.ncbi.nlm.nih.gov/pubmed/34156339 ID - info:doi/10.2196/27623 ER - TY - JOUR AU - Tso, Foon Chak AU - Garikipati, Anurag AU - Green-Saxena, Abigail AU - Mao, Qingqing AU - Das, Ritankar PY - 2021/6/3 TI - Correlation of Population SARS-CoV-2 Cycle Threshold Values to Local Disease Dynamics: Exploratory Observational Study JO - JMIR Public Health Surveill SP - e28265 VL - 7 IS - 6 KW - reverse transcription polymerase chain reaction KW - testing KW - cycle threshold KW - COVID-19 KW - epidemiology KW - Rt KW - exploratory KW - correlation KW - population KW - threshold KW - disease dynamic KW - distribution KW - transmission N2 - Background: Despite the limitations in the use of cycle threshold (CT) values for individual patient care, population distributions of CT values may be useful indicators of local outbreaks. Objective: We aimed to conduct an exploratory analysis of potential correlations between the population distribution of cycle threshold (CT) values and COVID-19 dynamics, which were operationalized as percent positivity, transmission rate (Rt), and COVID-19 hospitalization count. Methods: In total, 148,410 specimens collected between September 15, 2020, and January 11, 2021, from the greater El Paso area were processed in the Dascena COVID-19 Laboratory. The daily median CT value, daily Rt, daily count of COVID-19 hospitalizations, daily change in percent positivity, and rolling averages of these features were plotted over time. Two-way scatterplots and linear regression were used to evaluate possible associations between daily median CT values and outbreak measures. Cross-correlation plots were used to determine whether a time delay existed between changes in daily median CT values and measures of community disease dynamics. Results: Daily median CT values negatively correlated with the daily Rt values (P<.001), the daily COVID-19 hospitalization counts (with a 33-day time delay; P<.001), and the daily changes in percent positivity among testing samples (P<.001). Despite visual trends suggesting time delays in the plots for median CT values and outbreak measures, a statistically significant delay was only detected between changes in median CT values and COVID-19 hospitalization counts (P<.001). Conclusions: This study adds to the literature by analyzing samples collected from an entire geographical area and contextualizing the results with other research investigating population CT values. UR - https://publichealth.jmir.org/2021/6/e28265 UR - http://dx.doi.org/10.2196/28265 UR - http://www.ncbi.nlm.nih.gov/pubmed/33999831 ID - info:doi/10.2196/28265 ER - TY - JOUR AU - Bongolan, Pearl Vena AU - Minoza, Antonio Jose Marie AU - de Castro, Romulo AU - Sevilleja, Emmanuel Jesus PY - 2021/5/31 TI - Age-Stratified Infection Probabilities Combined With a Quarantine-Modified Model for COVID-19 Needs Assessments: Model Development Study JO - J Med Internet Res SP - e19544 VL - 23 IS - 5 KW - COVID-19 KW - epidemic modeling KW - age stratification theory KW - infection probability KW - SEIR KW - mathematical modelling N2 - Background: Classic compartmental models such as the susceptible-exposed-infectious-removed (SEIR) model all have the weakness of assuming a homogenous population, where everyone has an equal chance of getting infected and dying. Since it was identified in Hubei, China, in December 2019, COVID-19 has rapidly spread around the world and been declared a pandemic. Based on data from Hubei, infection and death distributions vary with age. To control the spread of the disease, various preventive and control measures such as community quarantine and social distancing have been widely used. Objective: Our aim is to develop a model where age is a factor, considering the study area?s age stratification. Additionally, we want to account for the effects of quarantine on the SEIR model. Methods: We use the age-stratified COVID-19 infection and death distributions from Hubei, China (more than 44,672 infections as of February 11, 2020) as an estimate or proxy for a study area?s infection and mortality probabilities for each age group. We then apply these probabilities to the actual age-stratified population of Quezon City, Philippines, to predict infectious individuals and deaths at peak. Testing with different countries shows the predicted number of infectious individuals skewing with the country?s median age and age stratification, as expected. We added a Q parameter to the SEIR model to include the effects of quarantine (Q-SEIR). Results: The projections from the age-stratified probabilities give much lower predicted incidences of infection than the Q-SEIR model. As expected, quarantine tends to delay the peaks for both the exposed and infectious groups, and to ?flatten? the curve or lower the predicted values for each compartment. These two estimates were used as a range to inform the local government?s planning and response to the COVID-19 threat. Conclusions: Age stratification combined with a quarantine-modified model has good qualitative agreement with observations on infections and death rates. That younger populations will have lower death rates due to COVID-19 is a fair expectation for a disease where most fatalities are among older adults. UR - https://www.jmir.org/2021/5/e19544 UR - http://dx.doi.org/10.2196/19544 UR - http://www.ncbi.nlm.nih.gov/pubmed/33900929 ID - info:doi/10.2196/19544 ER - TY - JOUR AU - Nassar, Ali Abdulkareem AU - Abdelrazzaq, Hasan Mahmood AU - Almahaqri, Hamoud Ali AU - Al-Amad, Abdullah Mohammed AU - Al Serouri, Abduljabbar Abulwahed AU - Khader, Saleh Yousef PY - 2021/5/14 TI - Cutaneous Leishmaniasis Outbreak Investigation in Hajjah Governorate, Yemen, in 2018: Case-Control Study JO - JMIR Public Health Surveill SP - e27442 VL - 7 IS - 5 KW - cutaneous leishmaniasis KW - outbreak KW - risk factors KW - Yemen KW - Field Epidemiology Training Program N2 - Background: Cutaneous leishmaniasis (CL) is endemic in Yemen. About 4440 cases were reported in 2019. On July 23, 2018, a Hajjah governorate surveillance officer notified the Ministry of Public Health and Population about an increase in the number of CL cases in Bani-Oshb, Kuhlan district, Hajjah governorate. On July 24, 2018, Yemen Field Epidemiology Training Program sent a team to perform an investigation. Objective: We aimed to describe a CL outbreak in Hajjah governorate and determine its risk factors. Methods: A descriptive study and case-control study (1:1 ratio) were conducted. Cases included people who met the suspected or confirmed case definition of the World Health Organization and lived in Bani-Oshb subdistrict during the period from August 2017 to July 2018. Controls included people living for at least 1 year in Bani-Oshb without new or old skin lesions. Crude odds ratios (cORs) and adjusted odds ratios (aORs) with 95% CI were used to test the significance of associations. Results: We identified 30 CL cases. Among the 30 patients, 7 (23%) were younger than 5 years, 17 (57%) were 5 to 14 years, 17 (57%) were females, and 23 (77%) had one lesion. The attack rate was 7 per 1000 population in the age group <15 years and 1 per 1000 population in the age group ?15 years. On bivariate analysis, the following factors were significantly associated with CL: female gender (cOR 5.2, 95% CI 1.7-16.5), malnutrition (cOR 5.2, 95% CI 1.7-16.5), not using a bed net (cOR 14.5, 95% CI 1.7-122.4), poor house lighting (cOR 6.4, 95% CI 2.1-19.7), poor house hygiene (cOR 11.2, 95% CI 3.1-40.7), poor sanitation (cOR 14.5, 95% CI 1.7-122.4), living in houses without window nets (cOR 5.2, 95% CI 1.3-21.2), plantation around the house (cOR 6.5, 95% CI 2.1-20.5), animal barn inside or close to the house (cOR 9.3, 95% CI 1.9-46.7), raising animals (cOR 8.1, 95% CI 1.6-40.7), and having animal dung in or near the house (cOR 6.8, 95% CI 1.7-27.7). The following risk factors remained significant on multivariate stepwise analysis: female gender (aOR 22.7, 95% CI 1.6-320.5), malnutrition (aOR 17.2, 95% CI 1.3-225.8), poor house hygiene (aOR 45.6, 95% CI 2.5-846.4), plantation around the house (aOR 43.8, 95% CI 1.9-1009.9), and raising animals (aOR 287.1, 95% CI 5.4-15205.6). Conclusions: CL was endemic in Hajjah governorate, and an increase in cases was confirmed. Many individual, housing, and animal related factors were shown to contribute to CL endemicity. Implementation of control measures directed toward altering the factors favoring contact among vectors, reservoirs, and susceptible humans is strongly recommended to control future outbreaks. UR - https://publichealth.jmir.org/2021/5/e27442 UR - http://dx.doi.org/10.2196/27442 UR - http://www.ncbi.nlm.nih.gov/pubmed/33988521 ID - info:doi/10.2196/27442 ER - TY - JOUR AU - Lima, Yuri AU - Pinheiro, Wallace AU - Barbosa, Eduardo Carlos AU - Magalhães, Matheus AU - Chaves, Miriam AU - de Souza, Moreira Jano AU - Rodrigues, Sérgio AU - Xexéo, Geraldo PY - 2021/5/10 TI - Development of an Index for the Inspection of Aedes aegypti Breeding Sites in Brazil: Multi-criteria Analysis JO - JMIR Public Health Surveill SP - e19502 VL - 7 IS - 5 KW - multi-criteria analysis KW - public health KW - human sensors KW - vector surveillance KW - tropical diseases N2 - Background: Aedes aegypti is a vector for the transmission of diseases such as dengue fever, chikungunya, Zika fever, and yellow fever. In 2016, over 1 million cases of these diseases were reported in Brazil, which is an alarming public health issue. One of the ways of controlling this disease is by inspecting and neutralizing the places where A. aegypti lays its eggs. The Ministry of Planning, Development, and Administration of Brazil maintains the inspection statistics. Objective: We propose a multi-criteria analysis to create an index for A. aegypti inspections reported through the Ministry of Planning, Development, and Administration system of Brazil. Methods: Based on the repository from urban cleaning services combined with data on inspections conducted by government agencies in several Brazilian cities and municipalities, we selected and combined metrics, which we further ranked using the analytic hierarchy process methodology. We also developed risk maps based on the analytic hierarchy process ranking of the A. aegypti breeding sites. Results: Based on our analysis and the available data, the priority for inspections should consider the number of sick people (weight 0.350), medical evaluations (weight 0.239), inspections (weight 0.201), mosquito breeding sites (weight 0.126), and days of absence from work (weight 0.096). Conclusions: The proposed index could aid public health practitioners in preventing the appearance of new A. aegypti breeding sites. This information technology application can help solve such public health challenges. UR - https://publichealth.jmir.org/2021/5/e19502 UR - http://dx.doi.org/10.2196/19502 UR - http://www.ncbi.nlm.nih.gov/pubmed/33970118 ID - info:doi/10.2196/19502 ER - TY - JOUR AU - Poteat, Tonia AU - Gallo, C. Linda AU - Harkness, Audrey AU - Isasi, R. Carmen AU - Matthews, Phoenix AU - Schneiderman, Neil AU - Thyagarajan, Bharat AU - Daviglus, L. Martha AU - Sotres-Alvarez, Daniela AU - Perreira, M. Krista PY - 2021/5/6 TI - Influence of Stress, Gender, and Minority Status on Cardiovascular Disease Risk in the Hispanic/Latino Community: Protocol for a Longitudinal Observational Cohort Study JO - JMIR Res Protoc SP - e28997 VL - 10 IS - 5 KW - minority stress KW - cardiovascular disease KW - sexual and gender minorities KW - transgender KW - intersex KW - lesbian KW - bisexual KW - gay KW - Hispanic KW - Latino N2 - Background: Hispanic/Latino sexual and gender minorities (SGM) are the fastest growing ethnic group of SGM in the United States. Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among Hispanics/Latinos. SGM inequities in CVD risk have been identified as early as young adulthood, and minority stress has been identified as a potential mediator. Yet, the small number of ethnic or racial minority participants in SGM studies have precluded the examination of the intersections of sexual orientation, gender identity, and race and ethnicity. Objective: Minority stress models conceptualize relationships between stressors in minority groups and health outcomes. In this study, we will (1) examine the influence of sexual orientation and gender identity on CVD risk among all Hispanic Community Health Study/Study of Latinos (HCHS/SOL) participants at visit 3 (2021-2024; N~9300); (2) model pathways from sexual orientation and gender identity to CVD risk through stigma, discrimination, and stress in a 1:2 matched subcohort of SGM and non-SGM participants at visit 3 (n~1680); and (3) examine the influence of resilience factors on sexual orientation or gender identity and CVD risk relationships among subcohort participants at visit 3 (n~1680). Methods: This study will leverage existing data from the parent HCHS/SOL study (collected since 2008) while collecting new data on sexual orientation, gender identity, stigma, discrimination, stress, coping, social support, and CVD risk. Data analysis will follow the SGM minority stress model, which states that excess stigma against SGM populations leads to minority stress that increases CVD risk. In this model, coping and social support serve as resilience factors that can mitigate the impact of minority stress on CVD risk. Cross-sectional and longitudinal regression models as well as structural equation models will be used to test these relationships. Results: This study was funded by the National Heart, Lung, and Blood Institute in March 2020. Recruitment is scheduled to begin in the first quarter of 2021 and continue through 2024. Conclusions: Understanding the influence of stigma-induced stress on CVD risk among Hispanic/Latino SGM has significant implications for the development of culturally specific CVD risk reduction strategies. Study findings will be used to build on identified Hispanic/Latino cultural strengths to inform adaptation and testing of family and community acceptance interventions. International Registered Report Identifier (IRRID): PRR1-10.2196/28997 UR - https://www.researchprotocols.org/2021/5/e28997 UR - http://dx.doi.org/10.2196/28997 UR - http://www.ncbi.nlm.nih.gov/pubmed/33955843 ID - info:doi/10.2196/28997 ER - TY - JOUR AU - Post, Lori AU - Culler, Kasen AU - Moss, B. Charles AU - Murphy, L. Robert AU - Achenbach, J. Chad AU - Ison, G. Michael AU - Resnick, Danielle AU - Singh, Nadya Lauren AU - White, Janine AU - Boctor, J. Michael AU - Welch, B. Sarah AU - Oehmke, Francis James PY - 2021/4/28 TI - Surveillance of the Second Wave of COVID-19 in Europe: Longitudinal Trend Analyses JO - JMIR Public Health Surveill SP - e25695 VL - 7 IS - 4 KW - SARS-CoV-2 surveillance KW - wave two KW - second wave KW - global COVID surveillance KW - Europe Public Health Surveillance KW - Europe COVID KW - Europe surveillance metrics KW - dynamic panel data KW - generalized method of the moments KW - Europe econometrics KW - Europe SARS-CoV-2 KW - Europe COVID surveillance system KW - European COVID transmission speed KW - European COVID transmission acceleration KW - COVID transmission deceleration KW - COVID transmission jerk KW - COVID 7-day lag KW - SARS-CoV-2 KW - Arellano-Bond estimator KW - GMM KW - Albania KW - Andorra KW - Austria KW - Belarus KW - Belgium KW - Bosnia and Herzegovina KW - Bulgaria KW - Croatia KW - Czech Republic KW - Denmark KW - Estonia KW - Finland KW - France KW - Germany KW - Greece KW - Greenland KW - Hungary KW - Iceland KW - Ireland KW - Isle of Man KW - Italy KW - Latvia KW - Liechtenstein KW - Lithuania KW - Luxembourg KW - Moldova KW - Monaco KW - Montenegro KW - Netherlands KW - Norway KW - Poland KW - Portugal KW - Romania KW - San Marino KW - Serbia KW - Slovakia KW - Slovenia KW - Spain KW - Sweden KW - Switzerland KW - Ukraine KW - United Kingdom KW - Vatican City N2 - Background: The COVID-19 pandemic has severely impacted Europe, resulting in a high caseload and deaths that varied by country. The second wave of the COVID-19 pandemic has breached the borders of Europe. Public health surveillance is necessary to inform policy and guide leaders. Objective: This study aimed to provide advanced surveillance metrics for COVID-19 transmission that account for weekly shifts in the pandemic, speed, acceleration, jerk, and persistence, to better understand countries at risk for explosive growth and those that are managing the pandemic effectively. Methods: We performed a longitudinal trend analysis and extracted 62 days of COVID-19 data from public health registries. We used an empirical difference equation to measure the daily number of cases in Europe as a function of the prior number of cases, the level of testing, and weekly shift variables based on a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R. Results: New COVID-19 cases slightly decreased from 158,741 (week 1, January 4-10, 2021) to 152,064 (week 2, January 11-17, 2021), and cumulative cases increased from 22,507,271 (week 1) to 23,890,761 (week 2), with a weekly increase of 1,383,490 between January 10 and January 17. France, Germany, Italy, Spain, and the United Kingdom had the largest 7-day moving averages for new cases during week 1. During week 2, the 7-day moving average for France and Spain increased. From week 1 to week 2, the speed decreased (37.72 to 33.02 per 100,000), acceleration decreased (0.39 to ?0.16 per 100,000), and jerk increased (?1.30 to 1.37 per 100,000). Conclusions: The United Kingdom, Spain, and Portugal, in particular, are at risk for a rapid expansion in COVID-19 transmission. An examination of the European region suggests that there was a decrease in the COVID-19 caseload between January 4 and January 17, 2021. Unfortunately, the rates of jerk, which were negative for Europe at the beginning of the month, reversed course and became positive, despite decreases in speed and acceleration. Finally, the 7-day persistence rate was higher during week 2 than during week 1. These measures indicate that the second wave of the pandemic may be subsiding, but some countries remain at risk for new outbreaks and increased transmission in the absence of rapid policy responses. UR - https://publichealth.jmir.org/2021/4/e25695 UR - http://dx.doi.org/10.2196/25695 UR - http://www.ncbi.nlm.nih.gov/pubmed/33818391 ID - info:doi/10.2196/25695 ER - TY - JOUR AU - Fahim, Manal AU - Ghonim, Sood Hanaa Abu El AU - Roshdy, H. Wael AU - Naguib, Amel AU - Elguindy, Nancy AU - AbdelFatah, Mohamad AU - Hassany, Mohamed AU - Mohsen, Amira AU - Afifi, Salma AU - Eid, Alaa PY - 2021/4/28 TI - Coinfection With SARS-CoV-2 and Influenza A(H1N1) in a Patient Seen at an Influenza-like Illness Surveillance Site in Egypt: Case Report JO - JMIR Public Health Surveill SP - e27433 VL - 7 IS - 4 KW - influenza-like Illness KW - pandemic KW - SARS-CoV-2 KW - COVID-19 KW - influenza KW - virus KW - case study KW - Egypt KW - flu KW - coinfection KW - infectious disease KW - surveillance KW - outcome KW - demographic N2 - Background: Sentinel surveillance of influenza-like illness (ILI) in Egypt started in 2000 at 8 sentinel sites geographically distributed all over the country. In response to the COVID-19 pandemic, SARS-CoV-2 was added to the panel of viral testing by polymerase chain reaction for the first 2 patients with ILI seen at one of the sentinel sites. We report the first SARS-CoV-2 and influenza A(H1N1) virus co-infection with mild symptoms detected through routine ILI surveillance in Egypt. Objective: This report aims to describe how the case was identified and the demographic and clinical characteristics and outcomes of the patient. Methods: The case was identified by Central Public Health Laboratory staff, who contacted the ILI sentinel surveillance officer at the Ministry of Health. The case patient was contacted through a telephone call. Detailed information about the patient?s clinical picture, course of disease, and outcome was obtained. The contacts of the patient were investigated for acute respiratory symptoms, disease confirmation, and outcomes. Results: Among 510 specimens collected from patients with ILI symptoms from October 2019 to August 2020, 61 (12.0%) were COVID-19?positive and 29 (5.7%) tested positive for influenza, including 15 (51.7%) A(H1N1), 11 (38.0%) A(H3N2), and 3 (10.3%) influenza B specimens. A 21-year-old woman was confirmed to have SARS-CoV-2 and influenza A(H1N1) virus coinfection. She had a high fever of 40.2 °C and mild respiratory symptoms that resolved within 2 days with symptomatic treatment. All five of her family contacts had mild respiratory symptoms 2-3 days after exposure to the confirmed case, and their symptoms resolved without treatment or investigation. Conclusions: This case highlights the possible occurrence of SARS-CoV-2/influenza A(H1N1) coinfection in younger and healthy people, who may resolve the infection rapidly. We emphasize the usefulness of the surveillance system for detection of viral causative agents of ILI and recommend broadening of the testing panel, especially if it can guide case management. UR - https://publichealth.jmir.org/2021/4/e27433 UR - http://dx.doi.org/10.2196/27433 UR - http://www.ncbi.nlm.nih.gov/pubmed/33784634 ID - info:doi/10.2196/27433 ER - TY - JOUR AU - Wirtz, L. Andrea AU - Cooney, E. Erin AU - Stevenson, Megan AU - Radix, Asa AU - Poteat, Tonia AU - Wawrzyniak, J. Andrew AU - Cannon, M. Christopher AU - Schneider, S. Jason AU - Haw, Sonya J. AU - Case, James AU - Althoff, N. Keri AU - Humes, Elizabeth AU - Mayer, H. Kenneth AU - Beyrer, Chris AU - Rodriguez, E. Allan AU - Reisner, L. Sari AU - PY - 2021/4/26 TI - Digital Epidemiologic Research on Multilevel Risks for HIV Acquisition and Other Health Outcomes Among Transgender Women in Eastern and Southern United States: Protocol for an Online Cohort JO - JMIR Res Protoc SP - e29152 VL - 10 IS - 4 KW - transgender persons KW - United States KW - cohort studies KW - digital research KW - HIV infection KW - HIV testing KW - public health KW - online health KW - transgender KW - HIV N2 - Background: The HIV epidemic disproportionately impacts transgender women in the United States. Cohort studies identify unique risks for affected populations, but use of facility-based methods may bias findings towards individuals living in research catchment areas, more engaged in health services, or, in the case of transgender populations, those who are open about their transgender identity. Digital clinical trials and other online research methods are increasingly common, providing opportunity to reach those not commonly engaged in research. Simultaneously, there is a need to understand potential biases associated with digital research, how these methods perform, and whether they are accepted across populations. Objective: This study aims to assess the feasibility of developing and implementing an online cohort of transgender women to assess risks for HIV acquisition and other health experiences. Further, this study aims to evaluate how an online cohort compares to a site-based, technology-enhanced cohort for epidemiologic research. The overarching goal is to estimate incidence of HIV and other health outcomes among transgender women in eastern and southern United States. Methods: This substudy is part of a larger multisite prospective cohort (LITE) conducted among transgender women, which also includes a site-based, technology-enhanced cohort in 6 eastern and southern US cities. The online cohort was launched to enroll and follow participants across 72 cities in the same region and with similar demographic characteristics as the site-based cohort. Participants are followed for 24 months. Adult transgender women are recruited via convenience sampling (eg, peer referrals, social media, and dating apps). Participants reporting negative or unknown HIV status are enrolled in a baseline study visit, complete a sociobehavioral survey, and provide oral fluid specimens to test for HIV. Participants not living with HIV (lab-confirmed) at baseline are offered enrollment into the cohort; follow-up assessments occur every 6 months. Results: Enrollment into the online cohort launched in January 2019. Active recruitment stopped in May 2019, and enrollment officially closed in August 2020. A total of 580 participants enrolled into and are followed in the cohort. A recruitment-enrollment cascade was observed across screening, consent, and completion of study activities. Implementation experiences with HIV test kits highlight the need for heavy staff engagement to support participant engagement, visit completion, and retention, even with automated digital procedures. Conclusions: This study is responsive to increasing research interest in digital observational and intervention research, particularly for populations who are most affected by the HIV epidemic and for those who may otherwise not participate in person. The progression across stages of the recruitment-enrollment cascade provides useful insight for implementation of cohort studies in the online environment. International Registered Report Identifier (IRRID): DERR1-10.2196/29152 UR - https://www.researchprotocols.org/2021/4/e29152 UR - http://dx.doi.org/10.2196/29152 UR - http://www.ncbi.nlm.nih.gov/pubmed/33900202 ID - info:doi/10.2196/29152 ER - TY - JOUR AU - Yeung, YS Arnold AU - Roewer-Despres, Francois AU - Rosella, Laura AU - Rudzicz, Frank PY - 2021/4/23 TI - Machine Learning?Based Prediction of Growth in Confirmed COVID-19 Infection Cases in 114 Countries Using Metrics of Nonpharmaceutical Interventions and Cultural Dimensions: Model Development and Validation JO - J Med Internet Res SP - e26628 VL - 23 IS - 4 KW - COVID-19 KW - machine learning KW - nonpharmaceutical interventions KW - cultural dimensions KW - random forest KW - AdaBoost KW - forecast KW - informatics KW - epidemiology KW - artificial intelligence N2 - Background: National governments worldwide have implemented nonpharmaceutical interventions to control the COVID-19 pandemic and mitigate its effects. Objective: The aim of this study was to investigate the prediction of future daily national confirmed COVID-19 infection growth?the percentage change in total cumulative cases?across 14 days for 114 countries using nonpharmaceutical intervention metrics and cultural dimension metrics, which are indicative of specific national sociocultural norms. Methods: We combined the Oxford COVID-19 Government Response Tracker data set, Hofstede cultural dimensions, and daily reported COVID-19 infection case numbers to train and evaluate five non?time series machine learning models in predicting confirmed infection growth. We used three validation methods?in-distribution, out-of-distribution, and country-based cross-validation?for the evaluation, each of which was applicable to a different use case of the models. Results: Our results demonstrate high R2 values between the labels and predictions for the in-distribution method (0.959) and moderate R2 values for the out-of-distribution and country-based cross-validation methods (0.513 and 0.574, respectively) using random forest and adaptive boosting (AdaBoost) regression. Although these models may be used to predict confirmed infection growth, the differing accuracies obtained from the three tasks suggest a strong influence of the use case. Conclusions: This work provides new considerations in using machine learning techniques with nonpharmaceutical interventions and cultural dimensions as metrics to predict the national growth of confirmed COVID-19 infections. UR - https://www.jmir.org/2021/4/e26628 UR - http://dx.doi.org/10.2196/26628 UR - http://www.ncbi.nlm.nih.gov/pubmed/33844636 ID - info:doi/10.2196/26628 ER - TY - JOUR AU - Kwok, On Kin AU - Wei, In Wan AU - Huang, Ying AU - Kam, Man Kai AU - Chan, Yang Emily Ying AU - Riley, Steven AU - Chan, Henry Ho Hin AU - Hui, Cheong David Shu AU - Wong, Shan Samuel Yeung AU - Yeoh, Kiong Eng PY - 2021/4/16 TI - Evolving Epidemiological Characteristics of COVID-19 in Hong Kong From January to August 2020: Retrospective Study JO - J Med Internet Res SP - e26645 VL - 23 IS - 4 KW - SARS-CoV-2 KW - COVID-19 KW - evolving epidemiology KW - containment delay KW - serial interval KW - Hong Kong KW - epidemiology KW - public health KW - transmission KW - China KW - intervention KW - case study N2 - Background: COVID-19 has plagued the globe, with multiple SARS-CoV-2 clusters hinting at its evolving epidemiology. Since the disease course is governed by important epidemiological parameters, including containment delays (time between symptom onset and mandatory isolation) and serial intervals (time between symptom onsets of infector-infectee pairs), understanding their temporal changes helps to guide interventions. Objective: This study aims to characterize the epidemiology of the first two epidemic waves of COVID-19 in Hong Kong by doing the following: (1) estimating the containment delays, serial intervals, effective reproductive number (Rt), and proportion of asymptomatic cases; (2) identifying factors associated with the temporal changes of the containment delays and serial intervals; and (3) depicting COVID-19 transmission by age assortativity and types of social settings. Methods: We retrieved the official case series and the Apple mobility data of Hong Kong from January-August 2020. The empirical containment delays and serial intervals were fitted to theoretical distributions, and factors associated with their temporal changes were quantified in terms of percentage contribution (the percentage change in the predicted outcome from multivariable regression models relative to a predefined comparator). Rt was estimated with the best fitted distribution for serial intervals. Results: The two epidemic waves were characterized by imported cases and clusters of local cases, respectively. Rt peaked at 2.39 (wave 1) and 3.04 (wave 2). The proportion of asymptomatic cases decreased from 34.9% (0-9 years) to 12.9% (?80 years). Log-normal distribution best fitted the 1574 containment delays (mean 5.18 [SD 3.04] days) and the 558 serial intervals (17 negative; mean 4.74 [SD 4.24] days). Containment delays decreased with involvement in a cluster (percentage contribution: 10.08%-20.73%) and case detection in the public health care sector (percentage contribution: 27.56%, 95% CI 22.52%-32.33%). Serial intervals decreased over time (6.70 days in wave 1 versus 4.35 days in wave 2) and with tertiary transmission or beyond (percentage contribution: ?50.75% to ?17.31%), but were lengthened by mobility (percentage contribution: 0.83%). Transmission within the same age band was high (18.1%). Households (69.9%) and social settings (20.3%) were where transmission commonly occurred. Conclusions: First, the factors associated with reduced containment delays suggested government-enacted interventions were useful for achieving outbreak control and should be further encouraged. Second, the shorter serial intervals associated with the composite mobility index calls for empirical surveys to disentangle the role of different contact dimensions in disease transmission. Third, the presymptomatic transmission and asymptomatic cases underscore the importance of remaining vigilant about COVID-19. Fourth, the time-varying epidemiological parameters suggest the need to incorporate their temporal variations when depicting the epidemic trajectory. Fifth, the high proportion of transmission events occurring within the same age group supports the ban on gatherings outside of households, and underscores the need for residence-centered preventive measures. UR - https://www.jmir.org/2021/4/e26645 UR - http://dx.doi.org/10.2196/26645 UR - http://www.ncbi.nlm.nih.gov/pubmed/33750740 ID - info:doi/10.2196/26645 ER - TY - JOUR AU - Mahalingaiah, Shruthi AU - Cheng, Jojo J. AU - Winter, R. Michael AU - Rodriguez, Erika AU - Fruh, Victoria AU - Williams, Anna AU - Nguyen, MyMy AU - Madhavan, Rashmi AU - Karanja, Pascaline AU - MacRae, Jill AU - Konanki, Charan Sai AU - Lane, J. Kevin AU - Aschengrau, Ann PY - 2021/4/16 TI - Multimodal Recruitment to Study Ovulation and Menstruation Health: Internet-Based Survey Pilot Study JO - J Med Internet Res SP - e24716 VL - 23 IS - 4 KW - polycystic ovary syndrome KW - PCOS KW - menstrual cycle KW - multimodal recruitment strategy KW - epidemiology KW - recruitment KW - pilot KW - strategy KW - women KW - feasibility KW - online survey KW - ovulation KW - menstrual N2 - Background: Multimodal recruitment strategies are a novel way to increase diversity in research populations. However, these methods have not been previously applied to understanding the prevalence of menstrual disorders such as polycystic ovary syndrome. Objective: The purpose of this study was to test the feasibility of recruiting a diverse cohort to complete a web-based survey on ovulation and menstruation health. Methods: We conducted the Ovulation and Menstruation Health Pilot Study using a REDCap web-based survey platform. We recruited 200 women from a clinical population, a community fair, and the internet. Results: We recruited 438 women over 29 weeks between September 2017 and March 2018. After consent and eligibility determination, 345 enrolled, 278 started (clinic: n=43; community fair: n=61; internet: n=174), and 247 completed (clinic: n=28; community fair: n=60; internet: n=159) the survey. Among all participants, the median age was 25.0 (SD 6.0) years, mean BMI was 26.1 kg/m2 (SD 6.6), 79.7% (216/271) had a college degree or higher, and 14.6% (37/254) reported a physician diagnosis of polycystic ovary syndrome. Race and ethnicity distributions were 64.7% (176/272) White, 11.8% (32/272) Black/African American, 7.7% (21/272) Latina/Hispanic, and 5.9% (16/272) Asian individuals; 9.9% (27/272) reported more than one race or ethnicity. The highest enrollment of Black/African American individuals was in clinic (17/42, 40.5%) compared to 1.6% (1/61) in the community fair and 8.3% (14/169) using the internet. Survey completion rates were highest among those who were recruited from the internet (159/174, 91.4%) and community fairs (60/61, 98.4%) compared to those recruited in clinic (28/43, 65.1%). Conclusions: Multimodal recruitment achieved target recruitment in a short time period and established a racially diverse cohort to study ovulation and menstruation health. There were greater enrollment and completion rates among those recruited via the internet and community fair. UR - https://www.jmir.org/2021/4/e24716 UR - http://dx.doi.org/10.2196/24716 UR - http://www.ncbi.nlm.nih.gov/pubmed/33861203 ID - info:doi/10.2196/24716 ER - TY - JOUR AU - Guntur, Dole Robertus AU - Kingsley, Jonathan AU - Islam, Amirul Fakir M. PY - 2021/4/9 TI - Epidemiology of Malaria in East Nusa Tenggara Province in Indonesia: Protocol for a Cross-sectional Study JO - JMIR Res Protoc SP - e23545 VL - 10 IS - 4 KW - malaria KW - rural population KW - awareness KW - risk factors KW - health policy KW - World Health Organization N2 - Background: Malaria is a global pandemic that results in approximately 228 million cases globally; 3.5% of these cases are in Southeast Asian countries, including Indonesia. Following the World Health Organization (WHO) initiative, Indonesia is in the process of achieving malaria-free zone status by 2030. However, the eastern part of Indonesia, including the East Nusa Tenggara Province (ENTP), still has a disproportionately high rate of malaria. Objective: The aims of this cross-sectional study are to determine the awareness and knowledge, attitude, and practice toward various aspects of malaria among rural adults and their associated factors, including sociodemographic factors and ethnicities; assess the gap between coverage of, access to, and use of long-lasting insecticide-treated nets (LLINs) among the households; estimate the prevalence of and factors associated with malaria in rural adults; and develop a risk prediction model for malaria. Methods: A multistage cluster sampling procedure with a systematic random sampling procedure at cluster level 4 was applied to recruit 1503 adults aged 18 years or older from the ENTP. Each participant participated in a face-to-face interview to assess their awareness and knowledge, attitude, and practice toward aspects of malaria, practices of sleeping under LLINs, and history of malaria. Information on sociodemographic, environmental, and lifestyle factors was also documented. The proportion of knowledge, attitude, and practice toward aspects of malaria and their variations across different sociodemographic and ethnic groups will be analyzed using descriptive statistics and chi-square tests. Coverage and access to LLINs will be evaluated based on the WHO recommendations. Malaria risk factors will be analyzed using logistic regression. Multilevel logistic regression will be applied to estimate the risk score for malaria. Results: Of the total participants, 99.46% (1495/1503) of rural adults from 49 villages in the ENTP participated in a face-to-face interview from October to December 2019. The study results are expected to be published in peer-reviewed journals. Conclusions: The best malaria risk prediction model will be developed in this study. In this protocol, we developed a methodology to provide new evidence to guide health policy in supporting the ENTP government?s expectation to achieve the malaria-free rating by 2030. International Registered Report Identifier (IRRID): DERR1-10.2196/23545 UR - https://www.researchprotocols.org/2021/4/e23545 UR - http://dx.doi.org/10.2196/23545 UR - http://www.ncbi.nlm.nih.gov/pubmed/33835037 ID - info:doi/10.2196/23545 ER - TY - JOUR AU - Radu, Roxana AU - Hernández-Ortega, Sara AU - Borrega, Oriol AU - Palmeri, Avril AU - Athanasiou, Dimitrios AU - Brooke, Nicholas AU - Chapí, Inma AU - Le Corvec, Anaïs AU - Guglieri, Michela AU - Perera-Lluna, Alexandre AU - Garrido-Aguirre, Jon AU - Ryll, Bettina AU - Nafria Escalera, Begonya PY - 2021/3/29 TI - Global Collaborative Social Network (Share4Rare) to Promote Citizen Science in Rare Disease Research: Platform Development Study JO - JMIR Form Res SP - e22695 VL - 5 IS - 3 KW - Share4Rare KW - rare disease KW - citizen science KW - participatory medicine KW - natural history KW - genotype KW - phenotype N2 - Background: Rare disease communities are spread around the globe and segmented by their condition. Little research has been performed on the majority of rare diseases. Most patients who are affected by a rare disease have no research on their condition because of a lack of knowledge due to absence of common groups in the research community. Objective: We aimed to develop a safe and secure community of rare disease patients, without geographic or language barriers, to promote research. Methods: Cocreation design methodology was applied to build Share4Rare, with consultation and input through workshops from a variety of stakeholders (patients, caregivers, clinicians, and researchers). Results: The workshops allowed us to develop a layered version of the platform based on educating patients and caregivers with publicly accessible information, a secure community for the patients and caregivers, and a research section with the purpose of collecting patient information for analysis, which was the core and final value of the platform. Conclusions: Rare disease research requires global collaboration in which patients and caregivers have key roles. Collective intelligence methods implemented in digital platforms reduce geographic and language boundaries and involve patients in a unique and universal project. Their contributions are essential to increase the amount of scientific knowledge that experts have on rare diseases. Share4Rare has been designed as a global platform to facilitate the donation of clinical information to foster research that matters to patients with rare conditions. The codesign methods with patients have been essential to create a patient-centric design. UR - https://formative.jmir.org/2021/3/e22695 UR - http://dx.doi.org/10.2196/22695 UR - http://www.ncbi.nlm.nih.gov/pubmed/33779572 ID - info:doi/10.2196/22695 ER - TY - JOUR AU - Kolawole, Daniel AU - Raji, Hayatu AU - Okeke, Ifeanyi Malachy PY - 2021/3/26 TI - Phylogenetic and Mutational Analysis of Lassa Virus Strains Isolated in Nigeria: Proposal for an In Silico Study JO - JMIR Res Protoc SP - e23015 VL - 10 IS - 3 KW - Arenavirus KW - Bayesian phylogeny KW - epidemic KW - evolution KW - Lassa virus KW - Mammarenavirus KW - marker gene KW - molecular epidemiology KW - mutations KW - Nigeria N2 - 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 UR - https://www.researchprotocols.org/2021/3/e23015 UR - http://dx.doi.org/10.2196/23015 UR - http://www.ncbi.nlm.nih.gov/pubmed/33769296 ID - info:doi/10.2196/23015 ER - TY - JOUR AU - Ferris, B. Emily AU - Wyka, Katarzyna AU - Evenson, R. Kelly AU - Dorn, M. Joan AU - Thorpe, Lorna AU - Catellier, Diane AU - Huang, T-K Terry PY - 2021/3/24 TI - Recruitment and Retention Strategies for Community-Based Longitudinal Studies in Diverse Urban Neighborhoods JO - JMIR Form Res SP - e18591 VL - 5 IS - 3 KW - community-based KW - participant engagement KW - natural experiment KW - built environment intervention KW - health disparities KW - study adaptations UR - https://formative.jmir.org/2021/3/e18591 UR - http://dx.doi.org/10.2196/18591 UR - http://www.ncbi.nlm.nih.gov/pubmed/33759799 ID - info:doi/10.2196/18591 ER - TY - JOUR AU - Lynch, J. Christopher AU - Gore, Ross PY - 2021/3/23 TI - Short-Range Forecasting of COVID-19 During Early Onset at County, Health District, and State Geographic Levels Using Seven Methods: Comparative Forecasting Study JO - J Med Internet Res SP - e24925 VL - 23 IS - 3 KW - coronavirus disease 2019 KW - COVID-19 KW - infectious disease KW - emerging outbreak KW - forecasting KW - modeling and simulation KW - public health KW - modeling disease outbreaks N2 - Background: Forecasting methods rely on trends and averages of prior observations to forecast COVID-19 case counts. COVID-19 forecasts have received much media attention, and numerous platforms have been created to inform the public. However, forecasting effectiveness varies by geographic scope and is affected by changing assumptions in behaviors and preventative measures in response to the pandemic. Due to time requirements for developing a COVID-19 vaccine, evidence is needed to inform short-term forecasting method selection at county, health district, and state levels. Objective: COVID-19 forecasts keep the public informed and contribute to public policy. As such, proper understanding of forecasting purposes and outcomes is needed to advance knowledge of health statistics for policy makers and the public. Using publicly available real-time data provided online, we aimed to evaluate the performance of seven forecasting methods utilized to forecast cumulative COVID-19 case counts. Forecasts were evaluated based on how well they forecast 1, 3, and 7 days forward when utilizing 1-, 3-, 7-, or all prior?day cumulative case counts during early virus onset. This study provides an objective evaluation of the forecasting methods to identify forecasting model assumptions that contribute to lower error in forecasting COVID-19 cumulative case growth. This information benefits professionals, decision makers, and the public relying on the data provided by short-term case count estimates at varied geographic levels. Methods: We created 1-, 3-, and 7-day forecasts at the county, health district, and state levels using (1) a naïve approach, (2) Holt-Winters (HW) exponential smoothing, (3) a growth rate approach, (4) a moving average (MA) approach, (5) an autoregressive (AR) approach, (6) an autoregressive moving average (ARMA) approach, and (7) an autoregressive integrated moving average (ARIMA) approach. Forecasts relied on Virginia?s 3464 historical county-level cumulative case counts from March 7 to April 22, 2020, as reported by The New York Times. Statistically significant results were identified using 95% CIs of median absolute error (MdAE) and median absolute percentage error (MdAPE) metrics of the resulting 216,698 forecasts. Results: The next-day MA forecast with 3-day look-back length obtained the lowest MdAE (median 0.67, 95% CI 0.49-0.84, P<.001) and statistically significantly differed from 39 out of 59 alternatives (66%) to 53 out of 59 alternatives (90%) at each geographic level at a significance level of .01. For short-range forecasting, methods assuming stationary means of prior days? counts outperformed methods with assumptions of weak stationarity or nonstationarity means. MdAPE results revealed statistically significant differences across geographic levels. Conclusions: For short-range COVID-19 cumulative case count forecasting at the county, health district, and state levels during early onset, the following were found: (1) the MA method was effective for forecasting 1-, 3-, and 7-day cumulative case counts; (2) exponential growth was not the best representation of case growth during early virus onset when the public was aware of the virus; and (3) geographic resolution was a factor in the selection of forecasting methods. UR - https://www.jmir.org/2021/3/e24925 UR - http://dx.doi.org/10.2196/24925 UR - http://www.ncbi.nlm.nih.gov/pubmed/33621186 ID - info:doi/10.2196/24925 ER - TY - JOUR AU - Cerqueira-Silva, Thiago AU - Carreiro, Roberto AU - Nunes, Victor AU - Passos, Louran AU - Canedo, F. Bernardo AU - Andrade, Sofia AU - Ramos, P. Pablo Ivan AU - Khouri, Ricardo AU - Santos, Souza Carolina Barbosa AU - Nascimento, Santos Jedson Dos AU - Paste, Angélica Aurea AU - Paiva Filho, Mattos Ivan De AU - Santini-Oliveira, Marília AU - Cruz, Álvaro AU - Barral-Netto, Manoel AU - Boaventura, Viviane PY - 2021/3/4 TI - Bridging Learning in Medicine and Citizenship During the COVID-19 Pandemic: A Telehealth-Based Case Study JO - JMIR Public Health Surveill SP - e24795 VL - 7 IS - 3 KW - medical education KW - surveillance KW - COVID-19 KW - education KW - telehealth KW - training KW - impact KW - medical student KW - triage KW - epidemiology KW - monitoring N2 - Background: COVID-19 presented great challenges for not only those in the field of health care but also those undergoing medical training. The burden on health care services worldwide has limited the educational opportunities available for medical students due to social distancing requirements. Objective: In this paper, we describe a strategy that combines telehealth and medical training to mitigate the adverse effects of the COVID-19 pandemic. Methods: A toll-free telescreening service, Telecoronavirus, began operations in March 2020. This service was operated remotely by supervised medical students and was offered across all 417 municipalities (14.8 million inhabitants) in the Brazilian state of Bahia. Students recorded clinical and sociodemographic data by using a web-based application that was simultaneously accessed by medical volunteers for supervision purposes, as well as by state health authorities who conducted epidemiological surveillance and health management efforts. In parallel, students received up-to-date scientific information about COVID-19 via short educational videos prepared by professors. A continuously updated triage algorithm was conceived to provide consistent service. Results: The program operated for approximately 4 months, engaging 1396 medical students and 133 physicians. In total, 111,965 individuals residing in 343 municipalities used this service. Almost 70,000 individuals were advised to stay at home, and they received guidance to avoid disease transmission, potentially contributing to localized reductions in the spread of COVID-19. Additionally, the program promoted citizenship education for medical students, who were engaged in a real-life opportunity to fight the pandemic within their own communities. The objectives of the education, organization, and assistance domains of the Telecoronavirus program were successfully achieved according to the results of a web-based post-project survey that assessed physicians? and students? perceptions. Conclusions: In a prolonged pandemic scenario, a combination of remote tools and medical supervision via telehealth services may constitute a useful strategy for maintaining social distancing measures while preserving some practical aspects of medical education. A low-cost tool such as the Telecoronavirus program could be especially valuable in resource-limited health care scenarios, in addition to offering support for epidemiological surveillance actions. UR - https://publichealth.jmir.org/2021/3/e24795 UR - http://dx.doi.org/10.2196/24795 UR - http://www.ncbi.nlm.nih.gov/pubmed/33630746 ID - info:doi/10.2196/24795 ER - TY - JOUR AU - Cho, Sung-Yeon AU - Park, Sung-Soo AU - Song, Min-Kyu AU - Bae, Yi Young AU - Lee, Dong-Gun AU - Kim, Dong-Wook PY - 2021/2/22 TI - Prognosis Score System to Predict Survival for COVID-19 Cases: a Korean Nationwide Cohort Study JO - J Med Internet Res SP - e26257 VL - 23 IS - 2 KW - COVID-19 KW - length of stay KW - mortality KW - prognosis KW - triage KW - digital health KW - prediction KW - cohort KW - risk KW - allocation KW - disease management KW - intensive care KW - decision making N2 - Background: As the COVID-19 pandemic continues, an initial risk-adapted allocation is crucial for managing medical resources and providing intensive care. Objective: In this study, we aimed to identify factors that predict the overall survival rate for COVID-19 cases and develop a COVID-19 prognosis score (COPS) system based on these factors. In addition, disease severity and the length of hospital stay for patients with COVID-19 were analyzed. Methods: We retrospectively analyzed a nationwide cohort of laboratory-confirmed COVID-19 cases between January and April 2020 in Korea. The cohort was split randomly into a development cohort and a validation cohort with a 2:1 ratio. In the development cohort (n=3729), we tried to identify factors associated with overall survival and develop a scoring system to predict the overall survival rate by using parameters identified by the Cox proportional hazard regression model with bootstrapping methods. In the validation cohort (n=1865), we evaluated the prediction accuracy using the area under the receiver operating characteristic curve. The score of each variable in the COPS system was rounded off following the log-scaled conversion of the adjusted hazard ratio. Results: Among the 5594 patients included in this analysis, 234 (4.2%) died after receiving a COVID-19 diagnosis. In the development cohort, six parameters were significantly related to poor overall survival: older age, dementia, chronic renal failure, dyspnea, mental disturbance, and absolute lymphocyte count <1000/mm3. The following risk groups were formed: low-risk (score 0-2), intermediate-risk (score 3), high-risk (score 4), and very high-risk (score 5-7) groups. The COPS system yielded an area under the curve value of 0.918 for predicting the 14-day survival rate and 0.896 for predicting the 28-day survival rate in the validation cohort. Using the COPS system, 28-day survival rates were discriminatively estimated at 99.8%, 95.4%, 82.3%, and 55.1% in the low-risk, intermediate-risk, high-risk, and very high-risk groups, respectively, of the total cohort (P<.001). The length of hospital stay and disease severity were directly associated with overall survival (P<.001), and the hospital stay duration was significantly longer among survivors (mean 26.1, SD 10.7 days) than among nonsurvivors (mean 15.6, SD 13.3 days). Conclusions: The newly developed predictive COPS system may assist in making risk-adapted decisions for the allocation of medical resources, including intensive care, during the COVID-19 pandemic. UR - https://www.jmir.org/2021/2/e26257 UR - http://dx.doi.org/10.2196/26257 UR - http://www.ncbi.nlm.nih.gov/pubmed/33539312 ID - info:doi/10.2196/26257 ER - TY - JOUR AU - Mayer, Angel Miguel AU - Vidal-Alaball, Josep AU - Puigdellívol-Sánchez, Anna AU - Marín Gomez, X. Francesc AU - Leis, Angela AU - Mendioroz Peña, Jacobo PY - 2021/2/8 TI - Clinical Characterization of Patients With COVID-19 in Primary Care in Catalonia: Retrospective Observational Study JO - JMIR Public Health Surveill SP - e25452 VL - 7 IS - 2 KW - COVID-19 KW - risk factors KW - primary health care KW - angiotensin-converting enzyme inhibitors KW - angiotensin II type 2 receptor blockers KW - risk KW - characteristic KW - retrospective KW - observational KW - Spain KW - mortality N2 - Background: The country of Spain has one of the highest incidences of COVID-19, with more than 1,000,000 cases as of the end of October 2020. Patients with a history of chronic conditions, obesity, and cancer are at greater risk from COVID-19; moreover, concerns surrounding the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin type II receptor blockers (ARBs) and its relationship to COVID-19 susceptibility have increased since the beginning of the pandemic. Objective: The objectives of this study were to compare the characteristics of patients diagnosed with COVID-19 to those of patients without COVID-19 in primary care; to determine the risk factors associated with the outcome of mortality; and to determine the potential influence of certain medications, such as ACEIs and ARBs, on the mortality of patients with COVID-19. Methods: An observational retrospective study of patients diagnosed with COVID-19 in the Catalan Central Region of Spain between March 1 and August 17, 2020, was conducted. The data were obtained from the Primary Care Services Information Technologies System of the Catalan Institute of Health in Barcelona, Spain. Results: The study population included 348,596 patients (aged >15 years) registered in the Primary Care Services Information Technologies System of the Catalan Central Region. The mean age of the patients was 49.53 years (SD 19.42), and 31.17% of the patients were aged ?60 years. 175,484/348,596 patients (50.34%) were women. A total of 23,844/348,596 patients (6.84%) in the population studied were diagnosed with COVID-19 during the study period, and the most common clinical conditions of these patients were hypertension (5267 patients, 22.1%) and obesity (5181 patients, 21.7%). Overall, 2680/348,596 patients in the study population (0.77%) died during the study period. The number of deaths among patients without COVID-19 was 1825/324,752 (0.56%; mean age 80.6 years, SD 13.3), while among patients diagnosed with COVID-19, the number of deaths was 855/23,844 (3.58%; mean age 83.0 years, SD 10.80) with an OR of 6.58 (95% CI 6.06-7.15). Conclusions: We observed that women were more likely to contract COVID-19 than men. In addition, our study did not show that hypertension, obesity, or being treated with ACEIs or ARBs was linked to an increase in mortality in patients with COVID-19. Age is the main factor associated with mortality in patients infected with SARS-CoV-2. UR - http://publichealth.jmir.org/2021/2/e25452/ UR - http://dx.doi.org/10.2196/25452 UR - http://www.ncbi.nlm.nih.gov/pubmed/33496668 ID - info:doi/10.2196/25452 ER - TY - JOUR AU - Hannerz, Harald AU - Burr, Hermann AU - Soll-Johanning, Helle AU - Nielsen, Lindhardt Martin AU - Garde, Helene Anne AU - Flyvholm, Mari-Ann PY - 2021/2/5 TI - Prospective Associations Between Fixed-Term Contract Positions and Mental Illness Rates in Denmark?s General Workforce: Protocol for a Cohort Study JO - JMIR Res Protoc SP - e24392 VL - 10 IS - 2 KW - cohort study KW - fixed-term employment KW - fixed term contract KW - unemployment KW - psychotropic drugs KW - psychiatric hospital treatment N2 - Background: In 2018, 14% of employees in the European Union had fixed-term contracts. Fixed-term contract positions are often less secure than permanent contract positions. Perceived job insecurity has been associated with increased rates of mental ill health. However, the association between fixed-term contract positions and mental ill health is uncertain. A recent review concluded that the quality of most existing studies is low and that the results of the few studies with high quality are contradictory. Objective: This study aims to estimate the incidence rate ratios (RRs) of psychotropic drug use and psychiatric hospital treatment. These ratios will be considered, first, in relation to the contrast fixed-term versus permanent contract and, second, to fixed-term contract versus unemployment. Methods: Interview data with baseline information on employment status from the Danish Labor Force Surveys in the years 2001-2013 will be linked to data from national registers. Participants will be followed up for up to 5 years after the interview. Poisson regression will be used to estimate incidence RRs for psychiatric hospital treatment for mood, anxiety, or stress-related disorders and redeemed prescriptions for psychotropic drugs, as a function of employment status at baseline. The following contrasts will be considered: full-time temporary employment versus full-time permanent employment and temporary employment (regardless of weekly working hours) versus unemployment. The analyses will be controlled for a series of possible confounders. People who have received sickness benefits, have received social security cash benefits, have redeemed a prescription for psychotropic drugs, or have received psychiatric hospital treatment for a mental disorder sometime during a 1-year period preceding baseline will be excluded from the study. The study will include approximately 134,000 participants (13,000 unemployed, 106,000 with permanent contracts, and 15,000 with fixed-term contracts). We expect to find approximately 16,400 incident cases of redeemed prescriptions of psychotropic drugs and 2150 incident cases of psychiatric hospital treatment for mood, anxiety, or stress-related disorders. Results: We expect the analyses to be completed by the end of 2021 and the results to be published in mid-2022. Conclusions: The statistical power of the study will be large enough to test the hypothesis of a prospective association between fixed-term contract positions and mental illness in the general workforce of Denmark. International Registered Report Identifier (IRRID): DERR1-10.2196/24392 UR - https://www.researchprotocols.org/2021/2/e24392 UR - http://dx.doi.org/10.2196/24392 UR - http://www.ncbi.nlm.nih.gov/pubmed/33325837 ID - info:doi/10.2196/24392 ER - TY - JOUR AU - Jalilian Khave, Laya AU - Vahidi, Mohammad AU - Shirini, Dorsa AU - Sanadgol, Ghazal AU - Ashrafi, Farzad AU - Arab-Ahmadi, Mehran AU - Fatemi, Alireza AU - Shabani Barzegar, Minoosh AU - Hassanzadeh, Taha AU - Rezaei, Behandokht AU - Zali, Alireza AU - Ommi, Davood AU - Nohesara, Shabnam AU - Jalili Khoshnood, Reza AU - Abdi, Saeed AU - Pirsalehi, Ali AU - Masarat, Ehsan AU - Shokoohi, Mostafa AU - Karamouzian, Mohammad PY - 2021/2/2 TI - Clinical and Epidemiological Characteristics of Postdischarge Patients With COVID-19 in Tehran, Iran: Protocol for a Prospective Cohort Study (Tele-COVID-19 Study) JO - JMIR Res Protoc SP - e23316 VL - 10 IS - 2 KW - cohort studies KW - COVID-19 KW - health care delivery KW - Iran KW - medical education KW - telemedicine N2 - Background: COVID-19 was declared a pandemic on March 11, 2020. Given that the severe shortage of hospital beds has led to early discharge and insufficient patient education on home care routines and isolation protocols, the close follow-up of patients and their immediate relatives is an integral part of transitioning from hospital care to home care for patients with COVID-19. Objective: We designed the Tele-COVID-19 prospective cohort to follow-up with COVID-19 patients in Tehran, Iran, and improve health care delivery and the recording of postdischarge patients? clinical profiles. Methods: All adult patients who were admitted to the COVID-19 wards of teaching hospitals in Tehran, Iran were eligible to participate in this cohort study. At baseline, patients were recruited from 4 major hospitals from March 9, 2020 to May 20, 2020. Telephone follow-ups, which were led by volunteer medical students, were conducted on postdischarge days 1-3, 5, 7, 10, and 14. We collected data on a range of sociodemographic, epidemiological, and clinical characteristics by using a standard questionnaire. Results: Of the 950 patients with confirmed COVID-19 who were approached, 823 (response rate: 86.6%) consented and were enrolled into the cohort. Of the 823 participants, 449 (54.5%) were male. The mean age of participants was 50.1 years (SD 12.6 years). During the initial data collection phase, more than 5000 phone calls were made and over 577 reports of critical patients who were in need of urgent medical attention were recorded. Conclusions: The Tele-COVID-19 cohort will provide patients with sufficient education on home care and isolation, and medical advice on care and the proper use of drugs. In addition, by preventing unnecessary hospital returns and providing information on household SARS-CoV-2 transmission as early as possible, this cohort will help with effective disease management in resource-limited settings. International Registered Report Identifier (IRRID): DERR1-10.2196/23316 UR - https://www.researchprotocols.org/2021/2/e23316 UR - http://dx.doi.org/10.2196/23316 UR - http://www.ncbi.nlm.nih.gov/pubmed/33471777 ID - info:doi/10.2196/23316 ER - TY - JOUR AU - Burger, C. Zoe AU - Mehta, N. Shivani AU - Ortiz, Dayanna AU - Sor, Sekboppa AU - Kothari, Jigna AU - Lam, Yvonne AU - Meka, Meena AU - Meka, Ajay AU - Rodwell, Timothy PY - 2021/1/27 TI - Assessing COVID-19?Related Knowledge, Attitudes, and Practices Among Hispanic Primary Care Patients: Protocol for a Cross-sectional Survey Study JO - JMIR Res Protoc SP - e25265 VL - 10 IS - 1 KW - COVID-19 KW - knowledge KW - attitude KW - practices KW - Hispanic KW - California KW - protocol KW - cross-sectional KW - survey N2 - Background: Recent epidemiological data indicate that minority groups, especially Hispanic communities, experience higher rates of infection, hospitalization, and death due to COVID-19. It is important to understand the nature of this health disparity and the socioeconomic or behavioral factors that are placing Hispanic communities and other minority populations at higher risk for morbidity and mortality. Objective: The purpose of this project is to assess current COVID-19?related knowledge, attitudes, and practices (KAP) among a predominantly Hispanic population from Orange County, California, and identify risk factors that may contribute to increased susceptibility and vulnerability to contracting SARS-CoV-2. Methods: Our Orange County?wide community survey consists of quantitative survey questions in four domains: demographic information, COVID-19 knowledge questions, COVID-19 attitude questions, and COVID-19 practices questions. The survey questions are adapted from recent global KAP studies. Participants are being recruited from Amistad Medical Clinic, a private primary health clinic group in Orange County that treats a predominantly Hispanic population. Patients recruited during telehealth visits are surveyed remotely by telephone, and those recruited during in-person clinic visits are surveyed in person. Surveys are conducted by trained members of the study team who are native to the community setting. Results: As of October 12, 2020, we had recruited and enrolled 327 participants. Data collection occurred June 26th to October 30th. Data analysis is ongoing. Conclusions: Very few current COVID-19 studies focus on the perspective and experience of minority populations. Because Hispanic communities are disproportionately affected by COVID-19, it is important to understand the factors the contribute to this disparity and the next steps that should be taken to reduce the COVID-19 burden in this population. We believe that our study model of partnering with a local clinic system that serves our study population can be expanded to other settings to compare COVID-19 KAP and associated factors within different minority communities. International Registered Report Identifier (IRRID): DERR1-10.2196/25265 UR - http://www.researchprotocols.org/2021/1/e25265/ UR - http://dx.doi.org/10.2196/25265 UR - http://www.ncbi.nlm.nih.gov/pubmed/33406051 ID - info:doi/10.2196/25265 ER - TY - JOUR AU - Pluimakers, Vincent AU - Fiocco, Marta AU - van Atteveld, Jenneke AU - Hobbelink, Monique AU - Bresters, Dorine AU - Van Dulmen-den Broeder, Eline AU - Van der Heiden-van der Loo, Margriet AU - Janssens, O. Geert AU - Kremer, Leontien AU - Loonen, Jacqueline AU - Louwerens, Marloes AU - Van der Pal, Helena AU - Ronckers, Cécile AU - Van Santen, Hanneke AU - Versluys, Birgitta AU - De Vries, Andrica AU - Van den Heuvel-Eibrink, Marry AU - Neggers, Sebastian PY - 2021/1/27 TI - Metabolic Syndrome Parameters, Determinants, and Biomarkers in Adult Survivors of Childhood Cancer: Protocol for the Dutch Childhood Cancer Survivor Study on Metabolic Syndrome (Dutch LATER METS) JO - JMIR Res Protoc SP - e21256 VL - 10 IS - 1 KW - metabolic syndrome KW - childhood cancer survivor KW - Dutch Childhood Cancer Survivor Study KW - methodology KW - Dutch LATER METS N2 - Background: Potential late effects of treatment for childhood cancer include adiposity, insulin resistance, dyslipidemia, and hypertension. These risk factors cluster together as metabolic syndrome and increase the risk for development of diabetes mellitus and cardio- and cerebrovascular disease. Knowledge on risk factors, timely diagnosis, and preventive strategies is of importance to prevent cardio- and cerebrovascular complications and improve quality of life. Currently, no national cohort studies on the prevalence and determinants of metabolic syndrome in childhood cancer survivors, including biomarkers and genetic predisposition, are available. Objective: The objectives of the Dutch LATER METS study are to assess 1) the prevalence and risk factors of metabolic syndrome and its separate components, and 2) the potential diagnostic and predictive value of additional biomarkers for surveillance of metabolic syndrome in the national cohort of adult long-term survivors of childhood cancer. Methods: This is a cross-sectional study based on recruitment of all survivors treated in the Netherlands between 1963 and 2002. Metabolic syndrome will be classified according to the definitions of the third Adult Treatment Panel Report of the National Cholesterol Education Program as well as the Joint Interim Statement and compared to reference data. Dual-energy x-ray absorptiometry scans were performed to assess body composition in more detail. The effect of patient characteristics, previous treatment, and genetic variation on the risk of metabolic syndrome will be assessed. The diagnostic and predictive value of novel biomarkers will be tested. Results: Patient accrual started in 2016 and lasted until April 2020. A total of 2380 survivors from 7 pediatric oncology hospitals have participated. From July 2020, biomarker testing, single nucleotide polymorphism analysis, and data analysis will be performed. Conclusions: The Dutch LATER METS study will provide knowledge on clinical and genetic determinants of metabolic syndrome and the diagnostic value of biomarkers in childhood cancer survivors. The results of this study will be used to optimize surveillance guidelines for metabolic syndrome in survivors based on enhanced risk stratification and screening strategies. This will improve diagnosis of metabolic syndrome and prevent complications. International Registered Report Identifier (IRRID): DERR1-10.2196/21256 UR - https://www.researchprotocols.org/2021/1/e21256 UR - http://dx.doi.org/10.2196/21256 UR - http://www.ncbi.nlm.nih.gov/pubmed/32750002 ID - info:doi/10.2196/21256 ER - TY - JOUR AU - Jiang, Hui AU - Zhang, Guolong AU - Yin, Jinfeng AU - Zhao, Dongyang AU - Liu, Fangchao AU - Yao, Yuxia AU - Cai, Chao AU - Xu, Jiying AU - Li, Xinwei AU - Xu, Wangli AU - Li, Weimin PY - 2021/1/22 TI - Assessment of Strategies and Epidemiological Characteristics of Tuberculosis in Henan Province, China: Observational Study JO - JMIR Public Health Surveill SP - e24830 VL - 7 IS - 1 KW - notified pulmonary tuberculosis KW - Tuberculosis Information Management System KW - epidemiological characteristics KW - dynamic compartmental model KW - policy evaluation KW - N2 - Background: In 2005, China established an internet-based Tuberculosis Information Management System (TBIMS) to monitor changes in tuberculosis (TB). Many scholars have conducted epidemiological research using TBIMS; however, few studies assessing control strategies have been performed based on this platform data. Henan province is a high TB incidence area in China where, in addition to following the nationwide TB strategies, a series of local intervention combinations have been implemented. Objective: Our study aims to evaluate the impact of nationwide TB intervention combinations on epidemiological changes and determine whether Henan province can achieve the World Health Organization?s (WHO) goal of reducing TB incidence by 50% and TB mortality by 75% by the year 2025. Methods: We used descriptive statistical methods to show the spatial and temporal distribution of pulmonary tuberculosis (PTB) reported to the TBIMS database from 2005 to 2018, and logistic regression analysis was performed to identify the risk factors of bacteriological-positive TB. The dynamic compartmental model and Bayesian melding approach was adopted to estimate the burden of TB under the impact of different TB control policies. Results: In total, 976,526 PTB cases were notified to the TBIMS in Henan in a period of 14 years. Although the overall incidence of PTB declined from 91.4/105 to 58.5/105, and the overall incidence of bacteriological-positive PTB declined from 44.5/105 to 14.7/105, the WHO?s 2025 goal could not be met. The distribution of high incidence and poverty-stricken counties were basically overlapped. Men, farmers and herdsmen (in rural areas), and subjects aged ?60 years were more likely to develop bacteriological-positive PTB. The increasing treatment success for drug-susceptible tuberculosis and multidrug-resistant tuberculosis has not provided the desired reduction in incidence and mortality. Conclusions: To achieve the targeted goal, while improving the cure rate of TB, new active (rather than passive) detection and intervention strategies should be formulated based on epidemiological characteristics in Henan province. UR - http://publichealth.jmir.org/2021/1/e24830/ UR - http://dx.doi.org/10.2196/24830 UR - http://www.ncbi.nlm.nih.gov/pubmed/33480857 ID - info:doi/10.2196/24830 ER - TY - JOUR AU - Alves, Domingos AU - Yamada, Bettiol Diego AU - Bernardi, Andrade Filipe AU - Carvalho, Isabelle AU - Filho, Colombo Márcio Eloi AU - Neiva, Barros Mariane AU - Lima, Costa Vinícius AU - Félix, Maria Têmis PY - 2021/1/22 TI - Mapping, Infrastructure, and Data Analysis for the Brazilian Network of Rare Diseases: Protocol for the RARASnet Observational Cohort Study JO - JMIR Res Protoc SP - e24826 VL - 10 IS - 1 KW - rare disease KW - digital health KW - health observatory KW - data science KW - health network N2 - Background: A rare disease is a medical condition with low prevalence in the general population, but these can collectively affect up to 10% of the population. Thus, rare diseases have a significant impact on the health care system, and health professionals must be familiar with their diagnosis, management, and treatment. Objective: This paper aims to provide health indicators regarding the rare diseases in Brazil and to create a network of reference centers with health professionals from different regions of the country. RARASnet proposes to map, analyze, and communicate all the data regarding the infrastructure of the centers and the patients? progress or needs. The focus of the proposed study is to provide all the technical infrastructure and analysis, following the World Health Organization and the Brazilian Ministry of Health guidelines. Methods: To build this digitized system, we will provide a security framework to assure the privacy and protection of each patient when collecting data. Systems development life cycle methodologies will also be applied to align software development, infrastructure operation, and quality assurance. After data collection of all information designed by the specialists, the computational analysis, modeling, and results will be communicated in scientific research papers and a digital health observatory. Results: The project has several activities, and it is in an initial stage. Initially, a survey was given to all health care centers to understand the technical aspects of each network member, such as the existence of computers, technical support staff, and digitized systems. In this survey, we detected that 59% (23/39) of participating health units have electronic medical records, while 41% (16/39) have paper records. Therefore, we will have different strategies to access the data from each center in the data collection phase. Later, we will standardize and analyze the clinical and epidemiological data and use these data to develop a national network for monitoring rare diseases and a digital health observatory to make the information available. The project had its financing approved in December 2019. Retrospective data collection started in October 2020, and we expect to finish in January 2021. During the third quarter of 2020, we enrolled 40 health institutions from all regions of Brazil. Conclusions: The nature of rare disease diagnosis is complex and diverse, and many problems will be faced in the evolution of the project. However, decisions based on data analysis are the best option for the improvement of the rare disease network in Brazil. The creation of RARASnet, along with all the digitized infrastructure, can improve the accessibility of information and standardization of rare diseases in the country. International Registered Report Identifier (IRRID): DERR1-10.2196/24826 UR - http://www.researchprotocols.org/2021/1/e24826/ UR - http://dx.doi.org/10.2196/24826 UR - http://www.ncbi.nlm.nih.gov/pubmed/33480849 ID - info:doi/10.2196/24826 ER - TY - JOUR AU - Fundikira, Said Lulu AU - Chillo, Pilly AU - van Laake, W. Linda AU - Mutagaywa, Kato Reuben AU - Schmidt, Floriaan Amand AU - Kamuhabwa, Appolinary AU - Kwesigabo, Gideon AU - Asselbergs, W. Folkert PY - 2021/1/21 TI - Risk Factors and Prevalence of Dilated Cardiomyopathy in Sub-Saharan Africa: Protocol for a Systematic Review JO - JMIR Res Protoc SP - e18229 VL - 10 IS - 1 KW - dilated cardiomyopathy KW - cardiomyopathy KW - heart failure KW - cardiovascular risk factors KW - sub-Saharan Africa N2 - 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 UR - http://www.researchprotocols.org/2021/1/e18229/ UR - http://dx.doi.org/10.2196/18229 UR - http://www.ncbi.nlm.nih.gov/pubmed/33475522 ID - info:doi/10.2196/18229 ER - TY - JOUR AU - Greene, K. Sharon AU - McGough, F. Sarah AU - Culp, M. Gretchen AU - Graf, E. Laura AU - Lipsitch, Marc AU - Menzies, A. Nicolas AU - Kahn, Rebecca PY - 2021/1/15 TI - Nowcasting for Real-Time COVID-19 Tracking in New York City: An Evaluation Using Reportable Disease Data From Early in the Pandemic JO - JMIR Public Health Surveill SP - e25538 VL - 7 IS - 1 KW - COVID-19 KW - data quality KW - epidemiology KW - forecasting KW - infectious disease KW - morbidity and mortality trends KW - public health practice KW - surveillance N2 - Background: Nowcasting approaches enhance the utility of reportable disease data for trend monitoring by correcting for delays, but implementation details affect accuracy. Objective: To support real-time COVID-19 situational awareness, the New York City Department of Health and Mental Hygiene used nowcasting to account for testing and reporting delays. We conducted an evaluation to determine which implementation details would yield the most accurate estimated case counts. Methods: A time-correlated Bayesian approach called Nowcasting by Bayesian Smoothing (NobBS) was applied in real time to line lists of reportable disease surveillance data, accounting for the delay from diagnosis to reporting and the shape of the epidemic curve. We retrospectively evaluated nowcasting performance for confirmed case counts among residents diagnosed during the period from March to May 2020, a period when the median reporting delay was 2 days. Results: Nowcasts with a 2-week moving window and a negative binomial distribution had lower mean absolute error, lower relative root mean square error, and higher 95% prediction interval coverage than nowcasts conducted with a 3-week moving window or with a Poisson distribution. Nowcasts conducted toward the end of the week outperformed nowcasts performed earlier in the week, given fewer patients diagnosed on weekends and lack of day-of-week adjustments. When estimating case counts for weekdays only, metrics were similar across days when the nowcasts were conducted, with Mondays having the lowest mean absolute error of 183 cases in the context of an average daily weekday case count of 2914. Conclusions: Nowcasting using NobBS can effectively support COVID-19 trend monitoring. Accounting for overdispersion, shortening the moving window, and suppressing diagnoses on weekends?when fewer patients submitted specimens for testing?improved the accuracy of estimated case counts. Nowcasting ensured that recent decreases in observed case counts were not overinterpreted as true declines and supported officials in anticipating the magnitude and timing of hospitalizations and deaths and allocating resources geographically. UR - http://publichealth.jmir.org/2021/1/e25538/ UR - http://dx.doi.org/10.2196/25538 UR - http://www.ncbi.nlm.nih.gov/pubmed/33406053 ID - info:doi/10.2196/25538 ER - TY - JOUR AU - Churches, Timothy AU - Jorm, Louisa PY - 2020/9/18 TI - Flexible, Freely Available Stochastic Individual Contact Model for Exploring COVID-19 Intervention and Control Strategies: Development and Simulation JO - JMIR Public Health Surveill SP - e18965 VL - 6 IS - 3 KW - COVID-19 KW - epidemic curve KW - infection dynamics KW - public health interventions N2 - Background: Throughout March 2020, leaders in countries across the world were making crucial decisions about how and when to implement public health interventions to combat the coronavirus disease (COVID-19). They urgently needed tools to help them to explore what will work best in their specific circumstances of epidemic size and spread, and feasible intervention scenarios. Objective: We sought to rapidly develop a flexible, freely available simulation model for use by modelers and researchers to allow investigation of how various public health interventions implemented at various time points might change the shape of the COVID-19 epidemic curve. Methods: ?COVOID? (COVID-19 Open-Source Infection Dynamics) is a stochastic individual contact model (ICM), which extends the ICMs provided by the open-source EpiModel package for the R statistical computing environment. To demonstrate its use and inform urgent decisions on March 30, 2020, we modeled similar intervention scenarios to those reported by other investigators using various model types, as well as novel scenarios. The scenarios involved isolation of cases, moderate social distancing, and stricter population ?lockdowns? enacted over varying time periods in a hypothetical population of 100,000 people. On April 30, 2020, we simulated the epidemic curve for the three contiguous local areas (population 287,344) in eastern Sydney, Australia that recorded 5.3% of Australian cases of COVID-19 through to April 30, 2020, under five different intervention scenarios and compared the modeled predictions with the observed epidemic curve for these areas. Results: COVOID allocates each member of a population to one of seven compartments. The number of times individuals in the various compartments interact with each other and their probability of transmitting infection at each interaction can be varied to simulate the effects of interventions. Using COVOID on March 30, 2020, we were able to replicate the epidemic response patterns to specific social distancing intervention scenarios reported by others. The simulated curve for three local areas of Sydney from March 1 to April 30, 2020, was similar to the observed epidemic curve in terms of peak numbers of cases, total numbers of cases, and duration under a scenario representing the public health measures that were actually enacted, including case isolation and ramp-up of testing and social distancing measures. Conclusions: COVOID allows rapid modeling of many potential intervention scenarios, can be tailored to diverse settings, and requires only standard computing infrastructure. It replicates the epidemic curves produced by other models that require highly detailed population-level data, and its predicted epidemic curve, using parameters simulating the public health measures that were enacted, was similar in form to that actually observed in Sydney, Australia. Our team and collaborators are currently developing an extended open-source COVOID package comprising of a suite of tools to explore intervention scenarios using several categories of models. UR - https://publichealth.jmir.org/2020/3/e18965 UR - http://dx.doi.org/10.2196/18965 UR - http://www.ncbi.nlm.nih.gov/pubmed/32568729 ID - info:doi/10.2196/18965 ER - TY - JOUR AU - Hu, Guangyu AU - Li, Peiyi AU - Yuan, Changzheng AU - Tao, Chenglin AU - Wen, Hai AU - Liu, Qiannan AU - Qiu, Wuqi PY - 2020/8/27 TI - Information Disclosure During the COVID-19 Epidemic in China: City-Level Observational Study JO - J Med Internet Res SP - e19572 VL - 22 IS - 8 KW - information disclosure KW - COVID-19 KW - website KW - risk KW - communication KW - China KW - disclosure KW - pandemic KW - health information KW - public health N2 - Background: Information disclosure is a top priority for official responses to the COVID-19 pandemic. The timely and standardized information published by authorities as a response to the crisis can better inform the public and enable better preparations for the pandemic; however, there is limited evidence of any systematic analyses of the disclosed epidemic information. This in turn has important implications for risk communication. Objective: This study aimed to describe and compare the officially released content regarding local epidemic situations as well as analyze the characteristics of information disclosure through local communication in major cities in China. Methods: The 31 capital cities in mainland China were included in this city-level observational study. Data were retrieved from local municipalities and health commission websites as of March 18, 2020. A checklist was employed as a rapid qualitative assessment tool to analyze the information disclosure performance of each city. Descriptive analyses and data visualizations were produced to present and compare the comparative performances of the cities. Results: In total, 29 of 31 cities (93.5%) established specific COVID-19 webpages to disclose information. Among them, 12 of the city webpages were added to their corresponding municipal websites. A majority of the cities (21/31, 67.7%) published their first cases of infection in a timely manner on the actual day of confirmation. Regarding the information disclosures highlighted on the websites, news updates from local media or press briefings were the most prevalent (28/29, 96.6%), followed by epidemic surveillance (25/29, 86.2%), and advice for the public (25/29, 86.2%). Clarifications of misinformation and frequently asked questions were largely overlooked as only 2 cities provided this valuable information. The median daily update frequency of epidemic surveillance summaries was 1.2 times per day (IQR 1.0-1.3 times), and the majority of these summaries (18/25, 72.0%) also provided detailed information regarding confirmed cases. The reporting of key indicators in the epidemic surveillance summaries, as well as critical facts included in the confirmed case reports, varied substantially between cities. In general, the best performance in terms of timely reporting and the transparency of information disclosures were observed in the municipalities directly administered by the central government compared to the other cities. Conclusions: Timely and effective efforts to disclose information related to the COVID-19 epidemic have been made in major cities in China. Continued improvements to local authority reporting will contribute to more effective public communication and efficient public health research responses. The development of protocols and the standardization of epidemic message templates?as well as the use of uniform operating procedures to provide regular information updates?should be prioritized to ensure a coordinated national response. UR - http://www.jmir.org/2020/8/e19572/ UR - http://dx.doi.org/10.2196/19572 UR - http://www.ncbi.nlm.nih.gov/pubmed/32790640 ID - info:doi/10.2196/19572 ER - TY - JOUR AU - Jones, Kate AU - Basinas, Ioannis AU - Kromhout, Hans AU - van Tongeren, Martie AU - Harding, Anne-Helen AU - Cherrie, W. John AU - Povey, Andrew AU - Sidek Ahmad, Naim Zulkhairul AU - Fuhrimann, Samuel AU - Ohlander, Johan AU - Vermeulen, Roel AU - Galea, S. Karen PY - 2020/2/28 TI - Improving Exposure Assessment Methodologies for Epidemiological Studies on Pesticides: Study Protocol JO - JMIR Res Protoc SP - e16448 VL - 9 IS - 2 KW - pesticides KW - occupational exposure KW - epidemiology KW - algorithm KW - biomonitoring KW - urine KW - questionnaire N2 - Background: Exposure to certain pesticides has been associated with several chronic diseases. However, to determine the role of pesticides in the causation of such diseases, an assessment of historical exposures is required. Exposure measurement data are rarely available; therefore, assessment of historical exposures is frequently based on surrogate self-reported information, which has inherent limitations. Understanding the performance of the applied surrogate measures in the exposure assessment of pesticides is therefore important to allow proper evaluation of the risks. Objective: The Improving Exposure Assessment Methodologies for Epidemiological Studies on Pesticides (IMPRESS) project aims to assess the reliability and external validity of the surrogate measures used to assign exposure within individuals or groups of individuals, which are frequently based on self-reported data on exposure determinants. IMPRESS will also evaluate the size of recall bias on the misclassification of exposure to pesticides; this in turn will affect epidemiological estimates of the effect of pesticides on human health. Methods: The IMPRESS project will recruit existing cohort participants from previous and ongoing research studies primarily of epidemiological origin from Malaysia, Uganda, and the United Kingdom. Consenting participants of each cohort will be reinterviewed using an amended version of the original questionnaire addressing pesticide use characteristics administered to that cohort. The format and relevant questions will be retained but some extraneous questions from the original (eg, relating to health) will be excluded for ethical and practical reasons. The reliability of pesticide exposure recall over different time periods (<2 years, 6-12 years, and >15 years) will then be evaluated. Where the original cohort study is still ongoing, participants will also be asked if they wish to take part in a new exposure biomonitoring survey, which involves them providing urine samples for pesticide metabolite analysis and completing questionnaire information regarding their work activities at the time of sampling. The participant?s level of exposure to pesticides will be determined by analyzing the collected urine samples for selected pesticide metabolites. The biomonitoring measurement results will be used to assess the performance of algorithm-based exposure assessment methods used in epidemiological studies to estimate individual exposures during application and re-entry work. Results: The project was funded in September 2017. Enrollment and sample collection was completed for Malaysia in 2019 and is on-going for Uganda and the United Kingdom. Sample and data analysis will proceed in 2020 and the first results are expected to be submitted for publication in 2021. Conclusions: The study will evaluate the consistency of questionnaire data and accuracy of current algorithms in assessing pesticide exposures. It will indicate where amendments can be made to better capture exposure data for future epidemiology studies and thus improve the reliability of exposure-disease associations. International Registered Report Identifier (IRRID): PRR1-10.2196/16448 UR - http://www.researchprotocols.org/2020/2/e16448/ UR - http://dx.doi.org/10.2196/16448 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130188 ID - info:doi/10.2196/16448 ER - TY - JOUR AU - Nam, Min Sang AU - Peterson, A. Thomas AU - Butte, J. Atul AU - Seo, Yul Kyoung AU - Han, Wook Hyun PY - 2020/2/20 TI - Explanatory Model of Dry Eye Disease Using Health and Nutrition Examinations: Machine Learning and Network-Based Factor Analysis From a National Survey JO - JMIR Med Inform SP - e16153 VL - 8 IS - 2 KW - dry eye disease KW - epidemiology KW - machine learning KW - systems analysis KW - patient-specific modeling N2 - Background: Dry eye disease (DED) is a complex disease of the ocular surface, and its associated factors are important for understanding and effectively treating DED. Objective: This study aimed to provide an integrative and personalized model of DED by making an explanatory model of DED using as many factors as possible from the Korea National Health and Nutrition Examination Survey (KNHANES) data. Methods: Using KNHANES data for 2012 (4391 sample cases), a point-based scoring system was created for ranking factors associated with DED and assessing patient-specific DED risk. First, decision trees and lasso were used to classify continuous factors and to select important factors, respectively. Next, a survey-weighted multiple logistic regression was trained using these factors, and points were assigned using the regression coefficients. Finally, network graphs of partial correlations between factors were utilized to study the interrelatedness of DED-associated factors. Results: The point-based model achieved an area under the curve of 0.70 (95% CI 0.61-0.78), and 13 of 78 factors considered were chosen. Important factors included sex (+9 points for women), corneal refractive surgery (+9 points), current depression (+7 points), cataract surgery (+7 points), stress (+6 points), age (54-66 years; +4 points), rhinitis (+4 points), lipid-lowering medication (+4 points), and intake of omega-3 (0.43%-0.65% kcal/day; ?4 points). Among these, the age group 54 to 66 years had high centrality in the network, whereas omega-3 had low centrality. Conclusions: Integrative understanding of DED was possible using the machine learning?based model and network-based factor analysis. This method for finding important risk factors and identifying patient-specific risk could be applied to other multifactorial diseases. UR - http://medinform.jmir.org/2020/2/e16153/ UR - http://dx.doi.org/10.2196/16153 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130150 ID - info:doi/10.2196/16153 ER - TY - JOUR AU - Peng, Suyuan AU - Shen, Feichen AU - Wen, Andrew AU - Wang, Liwei AU - Fan, Yadan AU - Liu, Xusheng AU - Liu, Hongfang PY - 2019/12/10 TI - Detecting Lifestyle Risk Factors for Chronic Kidney Disease With Comorbidities: Association Rule Mining Analysis of Web-Based Survey Data JO - J Med Internet Res SP - e14204 VL - 21 IS - 12 KW - chronic kidney disease KW - association rule mining KW - Behavioral Risk Factor Surveillance System KW - noncommunicable diseases N2 - Background: The rise in the number of patients with chronic kidney disease (CKD) and consequent end-stage renal disease necessitating renal replacement therapy has placed a significant strain on health care. The rate of progression of CKD is influenced by both modifiable and unmodifiable risk factors. Identification of modifiable risk factors, such as lifestyle choices, is vital in informing strategies toward renoprotection. Modification of unhealthy lifestyle choices lessens the risk of CKD progression and associated comorbidities, although the lifestyle risk factors and modification strategies may vary with different comorbidities (eg, diabetes, hypertension). However, there are limited studies on suitable lifestyle interventions for CKD patients with comorbidities. Objective: The objectives of our study are to (1) identify the lifestyle risk factors for CKD with common comorbid chronic conditions using a US nationwide survey in combination with literature mining, and (2) demonstrate the potential effectiveness of association rule mining (ARM) analysis for the aforementioned task, which can be generalized for similar tasks associated with noncommunicable diseases (NCDs). Methods: We applied ARM to identify lifestyle risk factors for CKD progression with comorbidities (cardiovascular disease, chronic pulmonary disease, rheumatoid arthritis, diabetes, and cancer) using questionnaire data for 450,000 participants collected from the Behavioral Risk Factor Surveillance System (BRFSS) 2017. The BRFSS is a Web-based resource, which includes demographic information, chronic health conditions, fruit and vegetable consumption, and sugar- or salt-related behavior. To enrich the BRFSS questionnaire, the Semantic MEDLINE Database was also mined to identify lifestyle risk factors. Results: The results suggest that lifestyle modification for CKD varies among different comorbidities. For example, the lifestyle modification of CKD with cardiovascular disease needs to focus on increasing aerobic capacity by improving muscle strength or functional ability. For CKD patients with chronic pulmonary disease or rheumatoid arthritis, lifestyle modification should be high dietary fiber intake and participation in moderate-intensity exercise. Meanwhile, the management of CKD patients with diabetes focuses on exercise and weight loss predominantly. Conclusions: We have demonstrated the use of ARM to identify lifestyle risk factors for CKD with common comorbid chronic conditions using data from BRFSS 2017. Our methods can be generalized to advance chronic disease management with more focused and optimized lifestyle modification of NCDs. UR - https://www.jmir.org/2019/12/e14204 UR - http://dx.doi.org/10.2196/14204 UR - http://www.ncbi.nlm.nih.gov/pubmed/31821152 ID - info:doi/10.2196/14204 ER - TY - JOUR AU - Speaks, Hannah AU - Falise, Alyssa AU - Grosgebauer, Kaitlin AU - Duncan, Dustin AU - Carrico, Adam PY - 2019/12/10 TI - Racial Disparities in Mortality Among American Film Celebrities: A Wikipedia-Based Retrospective Cohort Study JO - Interact J Med Res SP - e13871 VL - 8 IS - 4 KW - continental population groups KW - internet KW - mortality KW - race N2 - Background: In the United States, well-documented racial disparities in health outcomes are frequently attributed to racial bias and socioeconomic inequalities. However, it remains unknown whether racial disparities in mortality persist among those with higher socioeconomic status (SES) and occupational prestige. Objective: As the celebrity population is generally characterized by high levels of SES and occupational prestige, this study aimed to examine survival differences between black and white film celebrities. Methods: Using a Web-based, open-source encyclopedia (ie, Wikipedia), data for 5829 entries of randomly selected American film actors and actresses born between 1900 and 2000 were extracted. A Kaplan-Meier survival curve was conducted using 4356 entries to compare the difference in survival by race. A Cox semiparametric regression analysis examined whether adjusting for year of birth, gender, and cause of death influenced differences in survival by race. Results: Most celebrities were non-Hispanic white (3847/4352, 88.4%), male (3565/4352, 81.9%), and born in the United States (4187/4352, 96.2%). Mean age at death for black celebrities (64.1; 95% CI 60.6-67.5 years) was 6.4 years shorter than that for white celebrities (70.5; 95% CI 69.6-71.4 years; P<.001). Black celebrities had a faster all-cause mortality rate using Kaplan-Meier survival function estimates and a log-rank test. However, in a Cox semiparametric regression, there was no longer a significant difference in survival times between black and white celebrities (hazard ratio 1.07; 95% CI 0.87-1.31). Conclusions: There is some evidence that racial disparities in all-cause mortality may persist at higher levels of SES, but this association was no longer significant in adjusted analyses. Further research is needed to examine if racial disparities in mortality are diminished at higher levels of SES among more representative populations. UR - http://www.i-jmr.org/2019/4/e13871/ UR - http://dx.doi.org/10.2196/13871 UR - http://www.ncbi.nlm.nih.gov/pubmed/31821148 ID - info:doi/10.2196/13871 ER - TY - JOUR AU - Kehe, Kai AU - Girgensohn, Roland AU - Swoboda, Walter AU - Bieler, Dan AU - Franke, Axel AU - Helm, Matthias AU - Kulla, Martin AU - Luepke, Kerstin AU - Morwinsky, Thomas AU - Blätzinger, Markus AU - Rossmann, Katalyn PY - 2019/08/19 TI - Analysis of Digital Documentation Speed and Sequence Using Digital Paper and Pen Technology During the Refugee Crisis in Europe: Content Analysis JO - JMIR Mhealth Uhealth SP - e13516 VL - 7 IS - 8 KW - digital documentation KW - digital pen KW - digital paper KW - refugee camp KW - refugee crisis KW - Europe KW - Germany KW - epidemiology N2 - Background: The Syria crisis has forced more than 4 million people to leave their homeland. As a result, in 2016, an overwhelming number of refugees reached Germany. In response to this, it was of utmost importance to set up refugee camps and to provide humanitarian aid, but a health surveillance system was also implemented in order to obtain rapid information about emerging diseases. Objective: The present study describes the effects of using digital paper and pen (DPP) technology on the speed, sequence, and behavior of epidemiological documentation in a refugee camp. Methods: DPP technology was used to examine documentation speed, sequence, and behavior. The data log of the digital pens used to fill in the documentation was analyzed, and each pen stroke in a field was recorded using a timestamp. Documentation time was the difference between first and last stroke on the paper, which includes clinical examination and translation. Results: For three months, 495 data sets were recorded. After corrections had been made, 421 data sets were considered valid and subjected to further analysis. The median documentation time was 41:41 min (interquartile range 29:54 min; mean 45:02 min; SD 22:28 min). The documentation of vital signs ended up having the strongest effect on the overall time of documentation. Furthermore, filling in the free-text field clinical findings or therapy or measures required the most time (mean 16:49 min; SD 20:32 min). Analysis of the documentation sequence revealed that the final step of coding the diagnosis was a time-consuming step that took place once the form had been completed. Conclusions: We concluded that medical documentation using DPP technology leads to both an increase in documentation speed and data quality through the compliance of the data recorders who regard the tool to be convenient in everyday routine. Further analysis of more data sets will allow optimization of the documentation form used. Thus, DPP technology is an effective tool for the medical documentation process in refugee camps. UR - http://mhealth.jmir.org/2019/8/e13516/ UR - http://dx.doi.org/10.2196/13516 UR - http://www.ncbi.nlm.nih.gov/pubmed/31429420 ID - info:doi/10.2196/13516 ER - TY - JOUR AU - Ye, Chengyin AU - Wang, Oliver AU - Liu, Modi AU - Zheng, Le AU - Xia, Minjie AU - Hao, Shiying AU - Jin, Bo AU - Jin, Hua AU - Zhu, Chunqing AU - Huang, Jung Chao AU - Gao, Peng AU - Ellrodt, Gray AU - Brennan, Denny AU - Stearns, Frank AU - Sylvester, G. Karl AU - Widen, Eric AU - McElhinney, B. Doff AU - Ling, Xuefeng PY - 2019/07/05 TI - A Real-Time Early Warning System for Monitoring Inpatient Mortality Risk: Prospective Study Using Electronic Medical Record Data JO - J Med Internet Res SP - e13719 VL - 21 IS - 7 KW - inpatients KW - mortality KW - risk assessment KW - electronic health records KW - machine learning N2 - Background: The rapid deterioration observed in the condition of some hospitalized patients can be attributed to either disease progression or imperfect triage and level of care assignment after their admission. An early warning system (EWS) to identify patients at high risk of subsequent intrahospital death can be an effective tool for ensuring patient safety and quality of care and reducing avoidable harm and costs. Objective: The aim of this study was to prospectively validate a real-time EWS designed to predict patients at high risk of inpatient mortality during their hospital episodes. Methods: Data were collected from the system-wide electronic medical record (EMR) of two acute Berkshire Health System hospitals, comprising 54,246 inpatient admissions from January 1, 2015, to September 30, 2017, of which 2.30% (1248/54,246) resulted in intrahospital deaths. Multiple machine learning methods (linear and nonlinear) were explored and compared. The tree-based random forest method was selected to develop the predictive application for the intrahospital mortality assessment. After constructing the model, we prospectively validated the algorithms as a real-time inpatient EWS for mortality. Results: The EWS algorithm scored patients? daily and long-term risk of inpatient mortality probability after admission and stratified them into distinct risk groups. In the prospective validation, the EWS prospectively attained a c-statistic of 0.884, where 99 encounters were captured in the highest risk group, 69% (68/99) of whom died during the episodes. It accurately predicted the possibility of death for the top 13.3% (34/255) of the patients at least 40.8 hours before death. Important clinical utilization features, together with coded diagnoses, vital signs, and laboratory test results were recognized as impactful predictors in the final EWS. Conclusions: In this study, we prospectively demonstrated the capability of the newly-designed EWS to monitor and alert clinicians about patients at high risk of in-hospital death in real time, thereby providing opportunities for timely interventions. This real-time EWS is able to assist clinical decision making and enable more actionable and effective individualized care for patients? better health outcomes in target medical facilities. UR - https://www.jmir.org/2019/7/e13719/ UR - http://dx.doi.org/10.2196/13719 UR - http://www.ncbi.nlm.nih.gov/pubmed/31278734 ID - info:doi/10.2196/13719 ER - TY - JOUR AU - Lalaye, Didier AU - de Bruijn, E. Mirjam AU - de Jong, PVM Tom PY - 2019/06/18 TI - Prevalence of Schistosoma Haematobium Measured by a Mobile Health System in an Unexplored Endemic Region in the Subprefecture of Torrock, Chad JO - JMIR Public Health Surveill SP - e13359 VL - 5 IS - 2 KW - Schistosoma haematobium KW - prevalence KW - Chad KW - neglected tropical diseases KW - mobile health N2 - Background: Schistosoma haematobium is a parasitic digenetic trematode responsible for schistosomiasis (also known as bilharzia). The disease is caused by penetration of the skin by the parasite, spread by intermediate host molluscs in stagnant waters, and can be treated by administration of praziquantel. Schistosomiasis is considered to be an important but neglected tropical disease. Objective: The aim of this pilot study was to investigate the prevalence of schistosomiasis in the subprefecture of Torrock, an endemic area in Chad where no earlier investigation had been conducted and no distribution system for pharmacotherapy has ever existed. Methods: This study examined 1875 children aged 1 to 14 years over a period of 1 year. After centrifugation, urine examination was performed by a direct microscopic investigation for eggs. The investigation was conducted with a mobile health (mHealth) approach, using short message service (SMS) for communication among parents, local health workers, a pharmacist, and a medical doctor. An initial awareness campaign requested parents to have their children examined for schistosomiasis. Urine was then collected at home by the parents following the SMS request. Urine results that proved positive were sent to a medical doctor by SMS, who in turn ordered a pharmacist by SMS to distribute praziquantel to the infected children. Results: Direct microscopic examination of urine found 467 positive cases (24.9% of the total sample). Of all male and female samples, 341 (34%) and 127 (14.4%) samples were positive, respectively. The infection rate was equally distributed over age groups. The newly developed mHealth system had a limited level of participation (8%) from an estimated total of 25,000 children in the target group. Conclusions: The prevalence of schistosomiasis in children in the subprefecture of Torrock is moderately high. Efforts will be required to enhance the awareness of parents and to reach a larger percentage of the population. Systematic governmental measures should be put in place as soon as possible to increase awareness in the area and to diagnose and treat cases of schistosomiasis. UR - http://publichealth.jmir.org/2019/2/e13359/ UR - http://dx.doi.org/10.2196/13359 UR - http://www.ncbi.nlm.nih.gov/pubmed/31215519 ID - info:doi/10.2196/13359 ER - TY - JOUR AU - Brenas, Hael Jon AU - Shin, Kyong Eun AU - Shaban-Nejad, Arash PY - 2019/05/21 TI - Adverse Childhood Experiences Ontology for Mental Health Surveillance, Research, and Evaluation: Advanced Knowledge Representation and Semantic Web Techniques JO - JMIR Ment Health SP - e13498 VL - 6 IS - 5 KW - ontologies KW - mental health surveillance KW - adverse childhood experiences KW - semantics KW - computational psychiatry N2 - Background: Adverse Childhood Experiences (ACEs), a set of negative events and processes that a person might encounter during childhood and adolescence, have been proven to be linked to increased risks of a multitude of negative health outcomes and conditions when children reach adulthood and beyond. Objective: To better understand the relationship between ACEs and their relevant risk factors with associated health outcomes and to eventually design and implement preventive interventions, access to an integrated coherent dataset is needed. Therefore, we implemented a formal ontology as a resource to allow the mental health community to facilitate data integration and knowledge modeling and to improve ACEs? surveillance and research. Methods: We use advanced knowledge representation and semantic Web tools and techniques to implement the ontology. The current implementation of the ontology is expressed in the description logic ALCRIQ(D), a sublogic of Web Ontology Language (OWL 2). Results: The ACEs Ontology has been implemented and made available to the mental health community and the public via the BioPortal repository. Moreover, multiple use-case scenarios have been introduced to showcase and evaluate the usability of the ontology in action. The ontology was created to be used by major actors in the ACEs community with different applications, from the diagnosis of individuals and predicting potential negative outcomes that they might encounter to the prevention of ACEs in a population and designing interventions and policies. Conclusions: The ACEs Ontology provides a uniform and reusable semantic network and an integrated knowledge structure for mental health practitioners and researchers to improve ACEs? surveillance and evaluation. UR - http://mental.jmir.org/2019/5/e13498/ UR - http://dx.doi.org/10.2196/13498 UR - http://www.ncbi.nlm.nih.gov/pubmed/31115344 ID - info:doi/10.2196/13498 ER - TY - JOUR AU - McManus, D. David AU - Trinquart, Ludovic AU - Benjamin, J. Emelia AU - Manders, S. Emily AU - Fusco, Kelsey AU - Jung, S. Lindsey AU - Spartano, L. Nicole AU - Kheterpal, Vik AU - Nowak, Christopher AU - Sardana, Mayank AU - Murabito, M. Joanne PY - 2019/03/01 TI - Design and Preliminary Findings From a New Electronic Cohort Embedded in the Framingham Heart Study JO - J Med Internet Res SP - e12143 VL - 21 IS - 3 KW - smartphone KW - tele-medicine KW - blood pressure monitoring KW - ambulatory KW - cohort studies N2 - Background: New models of scalable population-based data collection that integrate digital and mobile health (mHealth) data are necessary. Objective: The aim of this study was to describe a cardiovascular digital and mHealth electronic cohort (e-cohort) embedded in a traditional longitudinal cohort study, the Framingham Heart Study (FHS). Methods: We invited eligible and consenting FHS Generation 3 and Omni participants to download the electronic Framingham Heart Study (eFHS) app onto their mobile phones and co-deployed a digital blood pressure (BP) cuff. Thereafter, participants were also offered a smartwatch (Apple Watch). Participants are invited to complete surveys through the eFHS app, to perform weekly BP measurements, and to wear the smartwatch daily. Results: Up to July 2017, we enrolled 790 eFHS participants, representing 76% (790/1044) of potentially eligible FHS participants. eFHS participants were, on average, 53±8 years of age and 57% were women. A total of 85% (675/790) of eFHS participants completed all of the baseline survey and 59% (470/790) completed the 3-month survey. A total of 42% (241/573) and 76% (306/405) of eFHS participants adhered to weekly digital BP and heart rate (HR) uploads, respectively, over 12 weeks. Conclusions: We have designed an e-cohort focused on identifying novel cardiovascular disease risk factors using a new smartphone app, a digital BP cuff, and a smartwatch. Despite minimal training and support, preliminary findings over a 3-month follow-up period show that uptake is high and adherence to periodic app-based surveys, weekly digital BP assessments, and smartwatch HR measures is acceptable. UR - http://www.jmir.org/2019/3/e12143/ UR - http://dx.doi.org/10.2196/12143 UR - http://www.ncbi.nlm.nih.gov/pubmed/30821691 ID - info:doi/10.2196/12143 ER - TY - JOUR AU - Velappan, Nileena AU - Daughton, Rae Ashlynn AU - Fairchild, Geoffrey AU - Rosenberger, Earl William AU - Generous, Nicholas AU - Chitanvis, Elizabeth Maneesha AU - Altherr, Michael Forest AU - Castro, A. Lauren AU - Priedhorsky, Reid AU - Abeyta, Luis Esteban AU - Naranjo, A. Leslie AU - Hollander, Dawn Attelia AU - Vuyisich, Grace AU - Lillo, Maria Antonietta AU - Cloyd, Kathryn Emily AU - Vaidya, Rajendra Ashvini AU - Deshpande, Alina PY - 2019/02/25 TI - Analytics for Investigation of Disease Outbreaks: Web-Based Analytics Facilitating Situational Awareness in Unfolding Disease Outbreaks JO - JMIR Public Health Surveill SP - e12032 VL - 5 IS - 1 KW - epidemiology KW - infectious diseases KW - algorithm KW - public health informatics KW - web browser N2 - Background: Information from historical infectious disease outbreaks provides real-world data about outbreaks and their impacts on affected populations. These data can be used to develop a picture of an unfolding outbreak in its early stages, when incoming information is sparse and isolated, to identify effective control measures and guide their implementation. Objective: This study aimed to develop a publicly accessible Web-based visual analytic called Analytics for the Investigation of Disease Outbreaks (AIDO) that uses historical disease outbreak information for decision support and situational awareness of an unfolding outbreak. Methods: We developed an algorithm to allow the matching of unfolding outbreak data to a representative library of historical outbreaks. This process provides epidemiological clues that facilitate a user?s understanding of an unfolding outbreak and facilitates informed decisions about mitigation actions. Disease-specific properties to build a complete picture of the unfolding event were identified through a data-driven approach. A method of analogs approach was used to develop a short-term forecasting feature in the analytic. The 4 major steps involved in developing this tool were (1) collection of historic outbreak data and preparation of the representative library, (2) development of AIDO algorithms, (3) development of user interface and associated visuals, and (4) verification and validation. Results: The tool currently includes representative historical outbreaks for 39 infectious diseases with over 600 diverse outbreaks. We identified 27 different properties categorized into 3 broad domains (population, location, and disease) that were used to evaluate outbreaks across all diseases for their effect on case count and duration of an outbreak. Statistical analyses revealed disease-specific properties from this set that were included in the disease-specific similarity algorithm. Although there were some similarities across diseases, we found that statistically important properties tend to vary, even between similar diseases. This may be because of our emphasis on including diverse representative outbreak presentations in our libraries. AIDO algorithm evaluations (similarity algorithm and short-term forecasting) were conducted using 4 case studies and we have shown details for the Q fever outbreak in Bilbao, Spain (2014), using data from the early stages of the outbreak. Using data from only the initial 2 weeks, AIDO identified historical outbreaks that were very similar in terms of their epidemiological picture (case count, duration, source of exposure, and urban setting). The short-term forecasting algorithm accurately predicted case count and duration for the unfolding outbreak. Conclusions: AIDO is a decision support tool that facilitates increased situational awareness during an unfolding outbreak and enables informed decisions on mitigation strategies. AIDO analytics are available to epidemiologists across the globe with access to internet, at no cost. In this study, we presented a new approach to applying historical outbreak data to provide actionable information during the early stages of an unfolding infectious disease outbreak. UR - http://publichealth.jmir.org/2019/1/e12032/ UR - http://dx.doi.org/10.2196/12032 UR - http://www.ncbi.nlm.nih.gov/pubmed/30801254 ID - info:doi/10.2196/12032 ER - TY - JOUR AU - Nsabimana, Placide Alain AU - Uzabakiriho, Bernard AU - Kagabo, M. Daniel AU - Nduwayo, Jerome AU - Fu, Qinyouen AU - Eng, Allison AU - Hughes, Joshua AU - Sia, K. Samuel PY - 2018/08/07 TI - Bringing Real-Time Geospatial Precision to HIV Surveillance Through Smartphones: Feasibility Study JO - JMIR Public Health Surveill SP - e11203 VL - 4 IS - 3 KW - HIV surveillance KW - smartphones KW - mobile phones KW - geospatial data N2 - Background: Precise measurements of HIV incidences at community level can help mount a more effective public health response, but the most reliable methods currently require labor-intensive population surveys. Novel mobile phone technologies are being tested for adherence to medical appointments and antiretroviral therapy, but using them to track HIV test results with automatically generated geospatial coordinates has not been widely tested. Objective: We customized a portable reader for interpreting the results of HIV lateral flow tests and developed a mobile phone app to track HIV test results in urban and rural locations in Rwanda. The objective was to assess the feasibility of this technology to collect front line HIV test results in real time and with geospatial context to help measure HIV incidences and improve epidemiological surveillance. Methods: Twenty health care workers used the technology to track the test results of 2190 patients across 3 hospital sites (2 urban sites in Kigali and a rural site in the Western Province of Rwanda). Mobile phones for less than US $70 each were used. The mobile phone app to record HIV test results could take place without internet connectivity with uploading of results to the cloud taking place later with internet. Results: A total of 91.51% (2004/2190) of HIV test results could be tracked in real time on an online dashboard with geographical resolution down to street level. Out of the 20 health care workers, 14 (70%) would recommend the lateral flow reader, and 100% would recommend the mobile phone app. Conclusions: Smartphones have the potential to simplify the input of HIV test results with geospatial context and in real time to improve public health surveillance of HIV. UR - http://publichealth.jmir.org/2018/3/e11203/ UR - http://dx.doi.org/10.2196/11203 UR - http://www.ncbi.nlm.nih.gov/pubmed/30087088 ID - info:doi/10.2196/11203 ER - TY - JOUR AU - He, Zhe AU - Bian, Jiang AU - Carretta, J. Henry AU - Lee, Jiwon AU - Hogan, R. William AU - Shenkman, Elizabeth AU - Charness, Neil PY - 2018/04/12 TI - Prevalence of Multiple Chronic Conditions Among Older Adults in Florida and the United States: Comparative Analysis of the OneFlorida Data Trust and National Inpatient Sample JO - J Med Internet Res SP - e137 VL - 20 IS - 4 KW - medical informatics KW - chronic disease KW - comorbidity KW - geriatrics N2 - Background: Older patients with multiple chronic conditions are often faced with increased health care needs and subsequent higher medical costs, posing significant financial burden to patients, their caregivers, and the health care system. The increasing adoption of electronic health record systems and the proliferation of clinical data offer new opportunities for prevalence studies and for population health assessment. The last few years have witnessed an increasing number of clinical research networks focused on building large collections of clinical data from electronic health records and claims to make it easier and less costly to conduct clinical research. Objective: The aim of this study was to compare the prevalence of common chronic conditions and multiple chronic conditions in older adults between Florida and the United States using data from the OneFlorida Clinical Research Consortium and the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS). Methods: We first analyzed the basic demographic characteristics of the older adults in 3 datasets?the 2013 OneFlorida data, the 2013 HCUP NIS data, and the combined 2012 to 2016 OneFlorida data. Then we analyzed the prevalence of each of the 25 chronic conditions in each of the 3 datasets. We stratified the analysis of older adults with hypertension, the most prevalent condition. Additionally, we examined trends (ie, overall trends and then by age, race, and gender) in the prevalence of discharge records representing multiple chronic conditions over time for the OneFlorida (2012-2016) and HCUP NIS cohorts (2003-2013). Results: The rankings of the top 10 prevalent conditions are the same across the OneFlorida and HCUP NIS datasets. The most prevalent multiple chronic conditions of 2 conditions among the 3 datasets were?hyperlipidemia and hypertension; hypertension and ischemic heart disease; diabetes and hypertension; chronic kidney disease and hypertension; anemia and hypertension; and hyperlipidemia and ischemic heart disease. We observed increasing trends in multiple chronic conditions in both data sources. Conclusions: The results showed that chronic conditions and multiple chronic conditions are prevalent in older adults across Florida and the United States. Even though slight differences were observed, the similar estimates of prevalence of chronic conditions and multiple chronic conditions across OneFlorida and HCUP NIS suggested that clinical research data networks such as OneFlorida, built from heterogeneous data sources, can provide rich data resources for conducting large-scale secondary data analyses. UR - http://www.jmir.org/2018/4/e137/ UR - http://dx.doi.org/10.2196/jmir.8961 UR - http://www.ncbi.nlm.nih.gov/pubmed/29650502 ID - info:doi/10.2196/jmir.8961 ER - TY - JOUR AU - Stopka, J. Thomas AU - Brinkley-Rubinstein, Lauren AU - Johnson, Kendra AU - Chan, A. Philip AU - Hutcheson, Marga AU - Crosby, Richard AU - Burke, Deirdre AU - Mena, Leandro AU - Nunn, Amy PY - 2018/04/03 TI - HIV Clustering in Mississippi: Spatial Epidemiological Study to Inform Implementation Science in the Deep South JO - JMIR Public Health Surveill SP - e35 VL - 4 IS - 2 KW - hotspots KW - HIV KW - racial disparities KW - social determinants of health KW - HIV treatment KW - HIV screening N2 - Background: In recent years, more than half of new HIV infections in the United States occur among African Americans in the Southeastern United States. Spatial epidemiological analyses can inform public health responses in the Deep South by identifying HIV hotspots and community-level factors associated with clustering. Objective: The goal of this study was to identify and characterize HIV clusters in Mississippi through analysis of state-level HIV surveillance data. Methods: We used a combination of spatial epidemiology and statistical modeling to identify and characterize HIV hotspots in Mississippi census tracts (n=658) from 2008 to 2014. We conducted spatial analyses of all HIV infections, infections among men who have sex with men (MSM), and infections among African Americans. Multivariable logistic regression analyses identified community-level sociodemographic factors associated with HIV hotspots considering all cases. Results: There were HIV hotspots for the entire population, MSM, and African American MSM identified in the Mississippi Delta region, Southern Mississippi, and in greater Jackson, including surrounding rural counties (P<.05). In multivariable models for all HIV cases, HIV hotspots were significantly more likely to include urban census tracts (adjusted odds ratio [AOR] 2.01, 95% CI 1.20-3.37) and census tracts that had a higher proportion of African Americans (AOR 3.85, 95% CI 2.23-6.65). The HIV hotspots were less likely to include census tracts with residents who had less than a high school education (AOR 0.95, 95% CI 0.92-0.98), census tracts with residents belonging to two or more racial/ethnic groups (AOR 0.46, 95% CI 0.30-0.70), and census tracts that had a higher percentage of the population living below the poverty level (AOR 0.51, 95% CI 0.28-0.92). Conclusions: We used spatial epidemiology and statistical modeling to identify and characterize HIV hotspots for the general population, MSM, and African Americans. HIV clusters concentrated in Jackson and the Mississippi Delta. African American race and urban location were positively associated with clusters, whereas having less than a high school education and having a higher percentage of the population living below the poverty level were negatively associated with clusters. Spatial epidemiological analyses can inform implementation science and public health response strategies, including improved HIV testing, targeted prevention and risk reduction education, and tailored preexposure prophylaxis to address HIV disparities in the South. UR - http://publichealth.jmir.org/2018/2/e35/ UR - http://dx.doi.org/10.2196/publichealth.8773 UR - http://www.ncbi.nlm.nih.gov/pubmed/29615383 ID - info:doi/10.2196/publichealth.8773 ER - TY - JOUR AU - Argha, Ahmadreza AU - Savkin, Andrey AU - Liaw, Siaw-Teng AU - Celler, George Branko PY - 2018/03/16 TI - Effect of Seasonal Variation on Clinical Outcome in Patients with Chronic Conditions: Analysis of the Commonwealth Scientific and Industrial Research Organization (CSIRO) National Telehealth Trial JO - JMIR Med Inform SP - e16 VL - 6 IS - 1 KW - telehealth KW - telemonitoring KW - seasonal variation KW - clinical trial KW - vital signs KW - chronic disease N2 - Background: Seasonal variation has an impact on the hospitalization rate of patients with a range of cardiovascular diseases, including myocardial infarction and angina. This paper presents findings on the influence of seasonal variation on the results of a recently completed national trial of home telemonitoring of patients with chronic conditions, carried out at five locations along the east coast of Australia. Objective: The aim is to evaluate the effect of the seasonal timing of hospital admission and length of stay on clinical outcome of a home telemonitoring trial involving patients (age: mean 72.2, SD 9.4 years) with chronic conditions (chronic obstructive pulmonary disease coronary artery disease, hypertensive diseases, congestive heart failure, diabetes, or asthma) and to explore methods of minimizing the influence of seasonal variations in the analysis of the effect of at-home telemonitoring on the number of hospital admissions and length of stay (LOS). Methods: Patients were selected from a hospital list of eligible patients living with a range of chronic conditions. Each test patient was case matched with at least one control patient. A total of 114 test patients and 173 control patients were available in this trial. However, of the 287 patients, we only considered patients who had one or more admissions in the years from 2010 to 2012. Three different groups were analyzed separately because of substantially different climates: (1) Queensland, (2) Australian Capital Territory and Victoria, and (3) Tasmania. Time series data were analyzed using linear regression for a period of 3 years before the intervention to obtain an average seasonal variation pattern. A novel method that can reduce the impact of seasonal variation on the rate of hospitalization and LOS was used in the analysis of the outcome variables of the at-home telemonitoring trial. Results: Test patients were monitored for a mean 481 (SD 77) days with 87% (53/61) of patients monitored for more than 12 months. Trends in seasonal variations were obtained from 3 years? of hospitalization data before intervention for the Queensland, Tasmania, and Australian Capital Territory and Victoria subgroups, respectively. The maximum deviation from baseline trends for LOS was 101.7% (SD 42.2%), 60.6% (SD 36.4%), and 158.3% (SD 68.1%). However, by synchronizing outcomes to the start date of intervention, the impact of seasonal variations was minimized to a maximum of 9.5% (SD 7.7%), thus improving the accuracy of the clinical outcomes reported. Conclusions: Seasonal variations have a significant effect on the rate of hospital admission and LOS in patients with chronic conditions. However, the impact of seasonal variation on clinical outcomes (rate of admissions, number of hospital admissions, and LOS) of at-home telemonitoring can be attenuated by synchronizing the analysis of outcomes to the commencement dates for the telemonitoring of vital signs. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12613000635763; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364030&isReview=true (Archived by WebCite at http://www.webcitation.org/ 6xLPv9QDb) UR - http://medinform.jmir.org/2018/1/e16/ UR - http://dx.doi.org/10.2196/medinform.9680 UR - http://www.ncbi.nlm.nih.gov/pubmed/29549068 ID - info:doi/10.2196/medinform.9680 ER - TY - JOUR AU - Sohda, Satoshi AU - Suzuki, Kenta AU - Igari, Ichiro PY - 2017/11/27 TI - Relationship Between the Menstrual Cycle and Timing of Ovulation Revealed by New Protocols: Analysis of Data from a Self-Tracking Health App JO - J Med Internet Res SP - e391 VL - 19 IS - 11 KW - self-tracking KW - person generated health data KW - calendar calculation KW - fertility KW - menstrual cycle N2 - Background: There are many mobile phone apps aimed at helping women map their ovulation and menstrual cycles and facilitating successful conception (or avoiding pregnancy). These apps usually ask users to input various biological features and have accumulated the menstrual cycle data of a vast number of women. Objective: The purpose of our study was to clarify how the data obtained from a self-tracking health app for female mobile phone users can be used to improve the accuracy of prediction of the date of next ovulation. Methods: Using the data of 7043 women who had reliable menstrual and ovulation records out of 8,000,000 users of a mobile phone app of a health care service, we analyzed the relationship between the menstrual cycle length, follicular phase length, and luteal phase length. Then we fitted a linear function to the relationship between the length of the menstrual cycle and timing of ovulation and compared it with the existing calendar-based methods. Results: The correlation between the length of the menstrual cycle and the length of the follicular phase was stronger than the correlation between the length of the menstrual cycle and the length of the luteal phase, and there was a positive correlation between the lengths of past and future menstrual cycles. A strong positive correlation was also found between the mean length of past cycles and the length of the follicular phase. The correlation between the mean cycle length and the luteal phase length was also statistically significant. In most of the subjects, our method (ie, the calendar-based method based on the optimized function) outperformed the Ogino method of predicting the next ovulation date. Our method also outperformed the ovulation date prediction method that assumes the middle day of a mean menstrual cycle as the date of the next ovulation. Conclusions: The large number of subjects allowed us to capture the relationships between the lengths of the menstrual cycle, follicular phase, and luteal phase in more detail than previous studies. We then demonstrated how the present calendar methods could be improved by the better grouping of women. This study suggested that even without integrating various biological metrics, the dataset collected by a self-tracking app can be used to develop formulas that predict the ovulation day when the data are aggregated. Because the method that we developed requires data only on the first day of menstruation, it would be the best option for couples during the early stages of their attempt to have a baby or for those who want to avoid the cost associated with other methods. Moreover, the result will be the baseline for more advanced methods that integrate other biological metrics. UR - http://www.jmir.org/2017/11/e391/ UR - http://dx.doi.org/10.2196/jmir.7468 UR - http://www.ncbi.nlm.nih.gov/pubmed/29180346 ID - info:doi/10.2196/jmir.7468 ER - TY - JOUR UR - ID - ref1 ER - TY - JOUR AU - El Rifay, S. Amira AU - Elabd, A. Mona AU - Abu Zeid, Dina AU - Gomaa, R. Mokhtar AU - Tang, Li AU - McKenzie, P. Pamela AU - Webby, J. Richard AU - Ali, A. Mohamed AU - Kayali, Ghazi PY - 2015/06/22 TI - Household Transmission of Zoonotic Influenza Viruses in a Cohort of Egyptian Poultry Growers JO - JMIR Res Protoc SP - e74 VL - 4 IS - 2 KW - influenza KW - avian KW - epidemiology KW - cohort N2 - Background: The highly pathogenic avian influenza H5N1 viruses and the low pathogenic H9N2 viruses are enzootic in Egyptian poultry. Several cases of human infection with H5N1 were reported in Egypt. We previously determined that the seroprevalence of H5N1 antibodies in Egyptians exposed to poultry is 2.1% (15/708), suggesting that mild or subclinical infections with this virus occur. We aim to measure the incidence of avian influenza infection in Egyptians exposed to poultry, study risk factors of infection, study the resulting immune response, study household transmission rates, and characterize the viruses causing infections. Objective: The objective of the study is to design a 7-year, prospective, household-based cohort investigation to determine incidence and household transmission of avian influenza viruses in humans exposed to poultry. Methods: At baseline, we will collect sera to measure antibodies against influenza A. Field nurses will visit enrolled subjects at least weekly to check for influenza-like illness symptoms and verify influenza infection by a point of care rapid test. From subjects with influenza infection and their household contacts, we will collect nasal swabs, throat swabs, and nasal washes to characterize the antigenic and genetic makeup of influenza viruses infecting humans. The nurse will also obtain 2x 3-ml blood samples, one for serology, and another for isolating peripheral blood mononuclear cells. Results: Results from this cohort will enhance our understanding of the transmission of avian influenza viruses to humans in a country where such viruses are enzootic. Conclusions: This may enhance public health efforts aimed at reducing this burden. UR - http://www.researchprotocols.org/2015/2/e74/ UR - http://dx.doi.org/10.2196/resprot.4331 UR - http://www.ncbi.nlm.nih.gov/pubmed/26099368 ID - info:doi/10.2196/resprot.4331 ER - TY - JOUR AU - Krishnadath, SK Ingrid AU - Smits, CF Christel AU - Jaddoe, WV Vincent AU - Hofman, Albert AU - Toelsie, R. Jerry PY - 2015/06/17 TI - A National Surveillance Survey on Noncommunicable Disease Risk Factors: Suriname Health Study Protocol JO - JMIR Res Protoc SP - e75 VL - 4 IS - 2 KW - ethnicity KW - multistage cluster sample KW - noncommunicable disease risk factors KW - STEPwise approach to surveillance KW - Suriname N2 - Background: Noncommunicable diseases (NCDs) are the leading cause of death in low- and middle-income countries. Therefore, the surveillance of risk factors has become an issue of major importance for planning and implementation of preventive measures. Unfortunately, in these countries data on NCDs and their risk factors are limited. This also prevails in Suriname, a middle-income country of the Caribbean, with a multiethnic/multicultural population living in diverse residential areas. For these reasons, ?The Suriname Health Study? was designed. Objective: The main objective of this study is to estimate the prevalence of NCD risk factors, including metabolic syndrome, hypertension, and diabetes in Suriname. Differences between specific age groups, sexes, ethnic groups, and geographical areas will be emphasized. In addition, risk groups will be identified and targeted actions will be designed and evaluated. Methods: In this study, several methodologies were combined. A stratified multistage cluster sample was used to select the participants of 6 ethnic groups (Hindustani, Creole, Javanese, Maroon, Chinese, Amerindians, and mixed) divided into 5 age groups (between 15 and 65 years) who live in urban/rural areas or the hinterland. A standardized World Health Organization STEPwise approach to surveillance questionnaire was adapted and used to obtain information about demographic characteristics, lifestyle, and risk factors. Physical examinations were performed to measure blood pressure, height, weight, and waist circumference. Biochemical analysis of collected blood samples evaluated the levels of glucose, high-density-lipoprotein cholesterol, total cholesterol, and triglycerides. Statistical analysis will be used to identify the burden of modifiable and unmodifiable risk factors in the aforementioned subgroups. Subsequently, tailor-made interventions will be prepared and their effects will be evaluated. Results: The data as collected allow for national inference and valid analysis of the age, sex, and ethnicity subgroups in the Surinamese population. A publication of the basic survey results is anticipated in mid-2015. Secondary results on the effect of targeted lifestyle interventions are anticipated in late 2017. Conclusions: Using the data collected in this study, the national prevalence of NCD risk factors will be approximated and described in a diverse population. This study is an entry point for formulating the structure of NCD prevention and surveillance. UR - http://www.researchprotocols.org/2015/2/e75/ UR - http://dx.doi.org/10.2196/resprot.4205 UR - http://www.ncbi.nlm.nih.gov/pubmed/26085372 ID - info:doi/10.2196/resprot.4205 ER - TY - JOUR AU - Kotwal, Sradha AU - Webster, Angela AU - Cass, Alan AU - Gallagher, Martin PY - 2015/06/16 TI - Rural Versus Urban Health Service Utilization and Outcomes for Renal Patients in New South Wales: Protocol for a Data Linkage Study JO - JMIR Res Protoc SP - e73 VL - 4 IS - 2 KW - end stage kidney disease KW - chronic kidney disease KW - kidney transplant KW - data linkage KW - dialysis KW - rural health care KW - cohort study N2 - Background: Kidney disease is a significant burden on health systems globally, with the rising prevalence of end stage kidney disease in Australia mirrored in many other countries. Approximately 25% of the Australian population lives in regional and rural areas and accessing complex tertiary services is challenging. Objective: We aim to compare the burden and outcomes of chronic kidney disease and end stage kidney disease in rural and urban regions of New South Wales (Australia?s most populous state) using linked health data. Methods: This is a retrospective cohort study and we have defined two cohorts: one with end stage kidney disease and one with chronic kidney disease. The end stage kidney disease cohort was defined using the Australia and New Zealand Dialysis and Transplant Registry, identifying all patients living in NSW receiving renal replacement therapy at any time between 01/07/2000 and 31/07/2010. The chronic kidney disease cohort used the NSW Admitted Patient Data Collection (APDC) to identify patients with a diagnostic code relating to chronic renal failure during any admission between 01/07/2000 and 31/07/2010. Both cohorts were linked to the NSW APDC, the Registry of Births, Deaths and Marriages, and the Central Cancer Registry allowing derivation of outcomes by categories of geographical remoteness. Results: To date, we have identified 10,505 patients with 2,384,218 records in the end stage kidney disease cohort and 159,033 patients with 1,599,770 records in the chronic kidney disease cohort. Conclusions: This study will define the geographical distribution of end stage and chronic kidney disease and compare the health service utilization between rural and urban renal populations. UR - http://www.researchprotocols.org/2015/2/e73/ UR - http://dx.doi.org/10.2196/resprot.3299 UR - http://www.ncbi.nlm.nih.gov/pubmed/26082088 ID - info:doi/10.2196/resprot.3299 ER - TY - JOUR AU - Cattelani, Luca AU - Palumbo, Pierpaolo AU - Palmerini, Luca AU - Bandinelli, Stefania AU - Becker, Clemens AU - Chesani, Federico AU - Chiari, Lorenzo PY - 2015/02/18 TI - FRAT-up, a Web-based Fall-Risk Assessment Tool for Elderly People Living in the Community JO - J Med Internet Res SP - e41 VL - 17 IS - 2 KW - accidental falls KW - odds ratio KW - risk assessment KW - risk factors KW - ROC curve KW - aged N2 - Background: About 30% of people over 65 are subject to at least one unintentional fall a year. Fall prevention protocols and interventions can decrease the number of falls. To be effective, a prevention strategy requires a prior step to evaluate the fall risk of the subjects. Despite extensive research, existing assessment tools for fall risk have been insufficient for predicting falls. Objective: The goal of this study is to present a novel web-based fall-risk assessment tool (FRAT-up) and to evaluate its accuracy in predicting falls, within a context of community-dwelling persons aged 65 and up. Methods: FRAT-up is based on the assumption that a subject?s fall risk is given by the contribution of their exposure to each of the known fall-risk factors. Many scientific studies have investigated the relationship between falls and risk factors. The majority of these studies adopted statistical approaches, usually providing quantitative information such as odds ratios. FRAT-up exploits these numerical results to compute how each single factor contributes to the overall fall risk. FRAT-up is based on a formal ontology that enlists a number of known risk factors, together with quantitative findings in terms of odds ratios. From such information, an automatic algorithm generates a rule-based probabilistic logic program, that is, a set of rules for each risk factor. The rule-based program takes the health profile of the subject (in terms of exposure to the risk factors) and computes the fall risk. A Web-based interface allows users to input health profiles and to visualize the risk assessment for the given subject. FRAT-up has been evaluated on the InCHIANTI Study dataset, a representative population-based study of older persons living in the Chianti area (Tuscany, Italy). We compared reported falls with predicted ones and computed performance indicators. Results: The obtained area under curve of the receiver operating characteristic was 0.642 (95% CI 0.614-0.669), while the Brier score was 0.174. The Hosmer-Lemeshow test indicated statistical significance of miscalibration. Conclusions: FRAT-up is a web-based tool for evaluating the fall risk of people aged 65 or up living in the community. Validation results of fall risks computed by FRAT-up show that its performance is comparable to externally validated state-of-the-art tools. A prototype is freely available through a web-based interface. Trial Registration: ClinicalTrials.gov NCT01331512 (The InChianti Follow-Up Study); http://clinicaltrials.gov/show/NCT01331512 (Archived by WebCite at http://www.webcitation.org/6UDrrRuaR). UR - http://www.jmir.org/2015/2/e41/ UR - http://dx.doi.org/10.2196/jmir.4064 UR - http://www.ncbi.nlm.nih.gov/pubmed/25693419 ID - info:doi/10.2196/jmir.4064 ER - TY - JOUR AU - Nakamura, Yoko AU - Ghaibeh, Ammar A. AU - Setoguchi, Yoko AU - Mitani, Kazue AU - Abe, Yoshiro AU - Hashimoto, Ichiro AU - Moriguchi, Hiroki PY - 2015/02/11 TI - On-Admission Pressure Ulcer Prediction Using the Nursing Needs Score JO - JMIR Med Inform SP - e8 VL - 3 IS - 1 KW - pressure ulcer KW - nursing needs score KW - prediction KW - logistic regression KW - imbalanced data N2 - Background: Pressure ulcers (PUs) are considered a serious problem in nursing care and require preventive measures. Many risk assessment methods are currently being used, but most require the collection of data not available on admission. Although nurses assess the Nursing Needs Score (NNS) on a daily basis in Japanese acute care hospitals, these data are primarily used to standardize the cost of nursing care in the public insurance system for appropriate nurse staffing, and have never been used for PU risk assessment. Objective: The objective of this study was to predict the risk of PU development using only data available on admission, including the on-admission NNS score. Methods: Logistic regression was used to generate a prediction model for the risk of developing PUs after admission. A random undersampling procedure was used to overcome the problem of imbalanced data. Results: A combination of gender, age, surgical duration, and on-admission total NNS score (NNS group B; NNS-B) was the best predictor with an average sensitivity, specificity, and area under receiver operating characteristic curve (AUC) of 69.2% (6920/100), 82.8% (8280/100), and 84.0% (8400/100), respectively. The model with the median AUC achieved 80% (4/5) sensitivity, 81.3% (669/823) specificity, and 84.3% AUC. Conclusions: We developed a model for predicting PU development using gender, age, surgical duration, and on-admission total NNS-B score. These results can be used to improve the efficiency of nurses and reduce the number of PU cases by identifying patients who require further examination. UR - http://medinform.jmir.org/2015/1/e8/ UR - http://dx.doi.org/10.2196/medinform.3850 UR - http://www.ncbi.nlm.nih.gov/pubmed/25673118 ID - info:doi/10.2196/medinform.3850 ER - TY - JOUR AU - Hu, Zhongkai AU - Jin, Bo AU - Shin, Y. Andrew AU - Zhu, Chunqing AU - Zhao, Yifan AU - Hao, Shiying AU - Zheng, Le AU - Fu, Changlin AU - Wen, Qiaojun AU - Ji, Jun AU - Li, Zhen AU - Wang, Yong AU - Zheng, Xiaolin AU - Dai, Dorothy AU - Culver, S. Devore AU - Alfreds, T. Shaun AU - Rogow, Todd AU - Stearns, Frank AU - Sylvester, G. Karl AU - Widen, Eric AU - Ling, B. Xuefeng PY - 2015/01/13 TI - Real-Time Web-Based Assessment of Total Population Risk of Future Emergency Department Utilization: Statewide Prospective Active Case Finding Study JO - Interact J Med Res SP - e2 VL - 4 IS - 1 KW - ED KW - machine learning KW - HIE KW - EMR KW - modeling N2 - Background: An easily accessible real-time Web-based utility to assess patient risks of future emergency department (ED) visits can help the health care provider guide the allocation of resources to better manage higher-risk patient populations and thereby reduce unnecessary use of EDs. Objective: Our main objective was to develop a Health Information Exchange-based, next 6-month ED risk surveillance system in the state of Maine. Methods: Data on electronic medical record (EMR) encounters integrated by HealthInfoNet (HIN), Maine?s Health Information Exchange, were used to develop the Web-based surveillance system for a population ED future 6-month risk prediction. To model, a retrospective cohort of 829,641 patients with comprehensive clinical histories from January 1 to December 31, 2012 was used for training and then tested with a prospective cohort of 875,979 patients from July 1, 2012, to June 30, 2013. Results: The multivariate statistical analysis identified 101 variables predictive of future defined 6-month risk of ED visit: 4 age groups, history of 8 different encounter types, history of 17 primary and 8 secondary diagnoses, 8 specific chronic diseases, 28 laboratory test results, history of 3 radiographic tests, and history of 25 outpatient prescription medications. The c-statistics for the retrospective and prospective cohorts were 0.739 and 0.732 respectively. Integration of our method into the HIN secure statewide data system in real time prospectively validated its performance. Cluster analysis in both the retrospective and prospective analyses revealed discrete subpopulations of high-risk patients, grouped around multiple ?anchoring? demographics and chronic conditions. With the Web-based population risk-monitoring enterprise dashboards, the effectiveness of the active case finding algorithm has been validated by clinicians and caregivers in Maine. Conclusions: The active case finding model and associated real-time Web-based app were designed to track the evolving nature of total population risk, in a longitudinal manner, for ED visits across all payers, all diseases, and all age groups. Therefore, providers can implement targeted care management strategies to the patient subgroups with similar patterns of clinical histories, driving the delivery of more efficient and effective health care interventions. To the best of our knowledge, this prospectively validated EMR-based, Web-based tool is the first one to allow real-time total population risk assessment for statewide ED visits. UR - http://www.i-jmr.org/2015/1/e2/ UR - http://dx.doi.org/10.2196/ijmr.4022 UR - http://www.ncbi.nlm.nih.gov/pubmed/25586600 ID - info:doi/10.2196/ijmr.4022 ER - TY - JOUR PY - 2013// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e4549 VL - 5 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v5i1.4549 ID - info:doi/10.5210/ojphi.v5i1.4549 ER -