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Elfghi M, Dunne D, Jones J, Gibson I, Flaherty G, McEvoy JW, Sultan S, Jordan F, Tawfick W. Mobile health technologies to improve walking distance in people with intermittent claudication. Cochrane Database Syst Rev 2024; 2:CD014717. [PMID: 38353263 PMCID: PMC10865447 DOI: 10.1002/14651858.cd014717.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
BACKGROUND Peripheral arterial disease (PAD) is the obstruction or narrowing of the large arteries of the lower limbs, which can result in impaired oxygen supply to the muscle and other tissues during exercise, or even at rest in more severe cases. PAD is classified into five categories (Fontaine classification). It may be asymptomatic or various levels of claudication pain may be present; at a later stage, there may be ulceration or gangrene of the limb, with amputation occasionally being required. About 20% of people with PAD suffer from intermittent claudication (IC), which is muscular discomfort in the lower extremities induced by exertion and relieved by rest within 10 minutes; IC causes restriction of movement in daily life. Treatment for people with IC involves addressing lifestyle risk factors. Exercise is an important part of treatment, but supervised exercise programmes for individuals with IC have low engagement levels and high attrition rates. The use of mobile technologies has been suggested as a new way to engage people with IC in walking exercise interventions. The novelty of the intervention, low cost for the user, automation, and ease of access are some of the advantages mobile health (mhealth) technologies provide that give them the potential to be effective in boosting physical activity in adults. OBJECTIVES To assess the benefits and harms of mobile health (mhealth) technologies to improve walking distance in people with intermittent claudication. SEARCH METHODS The Cochrane Vascular Information Specialist conducted systematic searches of the Cochrane Vascular Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and CINAHL, and also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov. The most recent searches were carried out on 19 December 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) in people aged 18 years or over with symptomatic PAD and a clinical diagnosis of IC. We included RCTs comparing mhealth interventions to improve walking distance versus usual care (no intervention or non-exercise advice), exercise advice, or supervised exercise programmes. We excluded people with chronic limb-threatening ischaemia (Fontaine III and IV). DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were change in absolute walking distance from baseline, change in claudication distance from baseline, amputation-free survival, revascularisation-free survival. Our secondary outcomes were major adverse cardiovascular events, major adverse limb events, above-ankle amputation, quality of life, and adverse events. We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included four RCTs involving a total of 614 participants with a clinical diagnosis of IC. The duration of intervention of the four included RCTs ranged from 3 to 12 months. Participants were randomised to either mhealth or control (usual care or supervised exercise programme). All four studies had an unclear or high risk of bias in one or several domains. The most prevalent risk of bias was in the area of performance bias, which was rated high risk as it is not possible to blind participants and personnel in this type of trial. Based on GRADE criteria, we downgraded the certainty of the evidence to low, due to concerns about risk of bias, imprecision, and clinical inconsistency. Comparing mhealth with usual care, there was no clear evidence of an effect on absolute walking distance (mean difference 9.99 metres, 95% confidence interval (CI) -27.96 to 47.93; 2 studies, 503 participants; low-certainty evidence). None of the included studies reported on change in claudication walking distance, amputation-free survival, or revascularisation-free survival. Only one study reported on major adverse cardiovascular events (MACE) and found no clear difference between groups (risk ratio 1.37, 95% CI 0.07 to 28.17; 1 study, 305 participants; low-certainty evidence). None of the included studies reported on major adverse limb events (MALE) or above-ankle amputations. AUTHORS' CONCLUSIONS Mobile health technologies can be used to provide lifestyle interventions for people with chronic conditions, such as IC. We identified a limited number of studies that met our inclusion criteria. We found no clear difference between mhealth and usual care in improving absolute walking distance in people with IC; however, we judged the evidence to be low certainty. Larger, well-designed RCTs are needed to provide adequate statistical power to reliably evaluate the effects of mhealth technologies on walking distance in people with IC.
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Affiliation(s)
- Marah Elfghi
- School of Medicine, University of Galway, Galway, Ireland
| | - Denise Dunne
- National Institute for Prevention and Cardiovascular Health, Croí Heart and Stroke Centre, Newcastle, Galway, Ireland
- Croí Heart and Stroke Centre, Newcastle, Galway, Ireland
| | - Jennifer Jones
- Croí, The West of Ireland Cardiac Foundation, Galway, Ireland
| | - Irene Gibson
- Croí, The West of Ireland Cardiac Foundation, Galway, Ireland
| | | | | | - Sherif Sultan
- Vascular Surgery, Galway University Hospital, Galway, Ireland
| | - Fionnuala Jordan
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - Wael Tawfick
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, University College Hospital, Galway, Ireland
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Amiri P, Ahmadian L, Khajouei R. The applications and the effectiveness of mHealth interventions to manage lung cancer patients: a systematic review. HEALTH AND TECHNOLOGY 2023. [DOI: 10.1007/s12553-023-00735-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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da Silva HEC, Santos GNM, Ferreira Leite A, Mesquita CRM, de Souza Figueiredo PT, Miron Stefani C, de Santos Melo N. The feasibility of telehealth in the monitoring of head and neck cancer patients: a systematic review on remote technology, user adherence, user satisfaction, and quality of life. Support Care Cancer 2022; 30:8391-8404. [PMID: 35524146 DOI: 10.1007/s00520-022-07109-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 04/30/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This systematic review aimed to analyze the use of telehealth in monitoring patients with head and neck cancer regarding the application used, user adherence to technology, user satisfaction, and user quality of life. MATERIALS AND METHODS A search strategy was developed using the PICO acronym and the terms "Head and Neck Cancer," "Telehealth," "Mobile Application," and "Supportive Care." A broad literature search was performed on PubMed, Cochrane Library, Scopus, Web of Science, Lilacs, and Embase databases and on grey literature through Open Grey, Google Scholar, and Jstor, for studies comparing the monitoring of head and neck cancer patients with telehealth apps to the monitoring performed in a traditional way at health units. No study design, publication status, publication time, or language restrictions were applied. Pairs of reviewers worked independently for study selection and risk of bias assessment. The protocol was registered in PROSPERO and the PRISMA checklist used for reporting the review. RESULTS We found 393 references in the databases, 325 after duplicate removal; 19 met the criteria for full-text reading; 08 studies were included for qualitative synthesis. Although there was heterogeneity regarding the technology used, the studies included showed that remote monitoring and/or self-management of symptoms through mobile applications was feasible for most patients, with satisfactory degrees of acceptability, satisfaction, usability, and adherence. The health-related quality of life improved with the use of remote technologies for telehealth, associated with low to moderate self-efficacy, higher personal control, and higher knowledge of health with clinically acceptable levels of accuracy compared to traditional clinical evaluation. Even when the data presented were not statistically significant, patients reported improvement in health-related quality of life after the intervention. CONCLUSIONS Telehealth monitoring through the use of remote technologies presents itself as an alternative way of educating and supporting patients during the treatment of Head and Neck Cancer (HNC). There is the need for a more user-friendly interface, adequate user experience assessment, and the concrete applicability of telehealth technologies for monitoring patients with HNC in order to legitimize the cost-effectiveness of developing long-term multicenter longitudinal studies term.
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Affiliation(s)
- Helbert Eustáquio Cardoso da Silva
- Dentistry Department, Faculty of Health Science, Brasilia University, Brasília, Brazil. .,UnB - Campus Universitário Darcy Ribeiro, Brasília, DF, 70910-900, Brazil.
| | | | - André Ferreira Leite
- Dentistry Department, Faculty of Health Science, Brasilia University, Brasília, Brazil
| | | | | | | | - Nilce de Santos Melo
- Dentistry Department, Faculty of Health Science, Brasilia University, Brasília, Brazil
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A Performance Evaluation Matrix for Measuring the Life Satisfaction of Older Adults Using eHealth Wearables. Healthcare (Basel) 2022; 10:healthcare10040605. [PMID: 35455784 PMCID: PMC9025461 DOI: 10.3390/healthcare10040605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/24/2022] [Accepted: 03/18/2022] [Indexed: 02/04/2023] Open
Abstract
eHealth wearables can track users’ state of health, record their physiological data, and facilitate self-care. In this study, we examined whether they enhance older adults’ casual exercise willingness and life satisfaction. After reviewing the related literature, the performance and satisfaction of elements for older adults to use eHealth Wearables were determined. The elements were derived from the means–end chain analysis. Three dimensions, product attributes, beneficial consequences, personal values, and responding elements, were identified first. The Performance Evaluation Matrix (PEM) was then established to determine the elements to be improved. A total of 250 questionnaires were distributed, out of which 206 valid questionnaires were completed and returned. In the proposed PEM, the product attributes that were in the priority improvement zone were accessibility, learnability, usability, affordability, positioning, pedometer, heart rate monitor, and data feedback. These elements are the most essential properties in need of improvement.
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Feasibility of promoting physical activity using mHEALTH technology in rural women: the step-2-it study. BMC Womens Health 2021; 21:415. [PMID: 34915900 PMCID: PMC8679963 DOI: 10.1186/s12905-021-01561-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 12/03/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Rural women are more likely to be obese and have a higher risk for chronic disease than their non-rural counterparts. Inadequate physical activity (PA) at least in part contributes to this increased risk. Rural women face personal, social and environmental barriers to PA engagement. Interventions promoting walking among rural women have demonstrated success; however, few of these studies use text messaging to promote PA.
Methods
Step-2-It was a pilot study to assess the feasibility, acceptability, and effectiveness of text-messaging combined with a pedometer to promote PA, specifically walking among English-speaking women, aged 40 and older, living in a rural, northwest Illinois county. Enrolled participants completed baseline assessments, received pedometers and two types of automated text messages: motivational messages to encourage walking, and accountability messages to report pedometer steps. Participants engaged in 3, 6, 9, and 12-week follow-ups to download pedometer data, and completed post-intervention assessments at 12 weeks.
Results
Of the 44 enrolled participants, 35 participants (79.5%) completed the intervention. Among completers, the proportion meeting PA guidelines increased from 31.4% (11/35) at baseline to 48.6% (17/35) at post-intervention, those with no PA decreased from 20% (7/35) to 17.1% (6/35). During weeks 1-12, when participants received motivational text messages, average participant daily step count was 5926 ± 3590, and remained stable during the intervention. Pedometer readings were highly correlated with self-reported steps (r = 0.9703; p < 0.001).
Conclusion
Step-2-It was a feasible and acceptable walking intervention for older rural women. Technology, including text messaging, should be investigated further as an enhancement to interventions for rural women.
Trial Registration on Clinicaltrials.gov: NCT04812756, registered on March 22, 2021
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Elfghi M, Dunne D, Jones J, Gibson I, Flaherty G, McEvoy JW, Sultan S, Jordan F, Tawfick W. Mobile health technologies to improve walking distance in people with intermittent claudication. Hippokratia 2021. [DOI: 10.1002/14651858.cd014717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Marah Elfghi
- College of Medicine; National University of Ireland Galway; Galway Ireland
| | - Denise Dunne
- National Institute for Prevention and Cardiovascular Health; Croí Heart and Stroke Centre; Newcastle, Galway Ireland
- Croí Heart and Stroke Centre; Newcastle, Galway Ireland
| | - Jennifer Jones
- Croí, The West of Ireland Cardiac Foundation; Galway Ireland
| | - Irene Gibson
- Croí, The West of Ireland Cardiac Foundation; Galway Ireland
| | - Gerard Flaherty
- School of Medicine; National University of Ireland; Galway Ireland
| | | | - Sherif Sultan
- Vascular Surgery; Galway University Hospital; Galway Ireland
| | - Fionnuala Jordan
- School of Nursing and Midwifery; National University of Ireland Galway; Galway Ireland
| | - Wael Tawfick
- Department of Vascular and Endovascular Surgery; Western Vascular Institute, University College Hospital; Galway Ireland
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Technological innovations to improve health outcome in type 2 diabetes mellitus: A randomized controlled study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2020.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Analyzing Older Adults' Perceived Values of Using Smart Bracelets by Means-End Chain. Healthcare (Basel) 2020; 8:healthcare8040494. [PMID: 33218065 PMCID: PMC7712386 DOI: 10.3390/healthcare8040494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 11/17/2022] Open
Abstract
To cope with the demands for medical care in an aging society, smart healthcare wearable devices that can measure physiological signals are being regarded as the primary tools in medical care programs, allowing the users to acquire basic health data. Although the smart healthcare wearable devices could be applied to disease management and prevention that could help older adults control their health, older adults must be willing and able to use and continue to use them. In this research, interviews conducted through means–end chain (MEC) and laddering were used to guide the older adults step-by-step by explaining abstract ideas and emphasizing value in their perceptions of specific attributes. A “hierarchical value map” was further constructed to confirm the perceived value of smart healthcare wearable devices to older adults. The research results showed that, in terms of attribute functions, seniors believed that smart bracelets in mobile health devices should have the attributes of safe use, real-time information feedback, correct data, comfortable wear, and clear screen. In terms of consequent benefits, older adults can use smart bracelets in mobile health devices to gain benefits in learning about smart products, understanding technology applications, increasing health awareness and relaxation, and satisfying curiosity. In terms of value goals, older adults want to achieve the value goals of a sense of social belonging, improved quality of life, and healthier bodies. Health is the most important thing for older adults, but previous research has often focused on the use of equipment for physical examinations; relatively few studies have allowed older adults to experience the equipment personally. The device can provide the ultimate value of long-term health promotion for older adults.
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Wang TF, Huang RC, Yang SC, Chou C, Chen LC. Evaluating the Effects of a Mobile Health App on Reducing Patient Care Needs and Improving Quality of Life After Oral Cancer Surgery: Quasiexperimental Study. JMIR Mhealth Uhealth 2020; 8:e18132. [PMID: 32716303 PMCID: PMC7418017 DOI: 10.2196/18132] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/26/2020] [Accepted: 06/03/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Intervention with a mobile Health (mHealth) app can improve the efficacy of early detection of oral cancer and the outcomes for patients taking oral anticancer medications. The quality of life of oral cancer patients is significantly reduced within three months after surgery; also, their needs for nursing care and health information increase, mainly due to side effects and associated psychological problems. OBJECTIVE This study aimed to evaluate changes in the care needs and quality of life of patients with oral cancer after receiving the intervention of a newly developed mHealth app. METHODS After surgery, oral cancer patients were divided into an experimental group (n=50) who received the mHealth app intervention and a control group (n=50) who received routine health care and instruction. After 3 months of intervention, survey questionnaires were used to assess the patients' quality of life, nursing care needs, and acceptance of the mHealth app. RESULTS The physiological care needs were significantly decreased in the experimental group compared with the control group (P<.05). Although the differences were not statistically significant, the psychological needs, communication needs, and care support needs all improved after the mHealth app intervention. The overall improvement in quality of life was higher in the experimental group than in the control group (-7.24 vs -4.36). In terms of intention to use, perceived usefulness, and perceived ease of use, the acceptability scores of the mHealth app were significantly increased after 3 months of intervention (P<.05). CONCLUSIONS Compared with routine health care and instruction, for patients after surgery, the education/information intervention using the mHealth app significantly reduced their nursing care needs, improved their quality of life, and increased their acceptance of using an mHealth app on a mobile device. These findings can provide a theoretical basis for future health care app design and improvement. This study suggests that an mHealth app should be incorporated into the routine care of oral cancer patients to provide medical information quickly and improve their self-management abilities, thereby reducing the patients' need for physiological care and improving their quality of life. TRIAL REGISTRATION ClinicalTrials.gov NCT04049968; https://www.clinicaltrials.gov/ct2/show/NCT04049968.
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Affiliation(s)
- Tze-Fang Wang
- School of Nursing, National Yang-Ming University, Taipei City, Taiwan
| | - Rou-Chen Huang
- School of Nursing, National Yang-Ming University, Taipei City, Taiwan
| | - Su-Chen Yang
- Department of Nursing, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chyuan Chou
- Excellent Dental Center, Taipei City, Taiwan
| | - Lee-Chen Chen
- Department of Nursing, Far Eastern Memorial Hospital, New Taipei City, Taiwan
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m-SFT: A Novel Mobile Health System to Assess the Elderly Physical Condition. SENSORS 2020; 20:s20051462. [PMID: 32155931 PMCID: PMC7085561 DOI: 10.3390/s20051462] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 03/01/2020] [Accepted: 03/02/2020] [Indexed: 02/06/2023]
Abstract
The development of innovative solutions that allow the aging population to remain healthier and independent longer is essential to alleviate the burden that this increasing segment of the population supposes for the long term sustainability of the public health systems. It has been claimed that promoting physical activity could prevent functional decline. However, given the vulnerability of this population, the activity prescription requires to be tailored to the individual's physical condition. We propose mobile Senior Fitness Test (m-SFT), a novel m-health system, that allows the health practitioner to determine the elderly physical condition by implementing a smartphone-based version of the senior fitness test (SFT). The technical reliability of m-SFT has been tested by carrying out a comparative study in seven volunteers (53-61 years) between the original SFT and the proposed m-health system obtaining high agreement (intra-class correlation coefficient (ICC) between 0.93 and 0.99). The system usability has been evaluated by 34 independent health experts (mean = 36.64 years; standard deviation = 6.26 years) by means of the System Usability Scale (SUS) obtaining an average SUS score of 84.4 out of 100. Both results point out that m-SFT is a reliable and easy to use m-health system for the evaluation of the elderly physical condition, also useful in intervention programs to follow-up the patient's evolution.
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Nätt D, Kugelberg U, Casas E, Nedstrand E, Zalavary S, Henriksson P, Nijm C, Jäderquist J, Sandborg J, Flinke E, Ramesh R, Örkenby L, Appelkvist F, Lingg T, Guzzi N, Bellodi C, Löf M, Vavouri T, Öst A. Human sperm displays rapid responses to diet. PLoS Biol 2019; 17:e3000559. [PMID: 31877125 PMCID: PMC6932762 DOI: 10.1371/journal.pbio.3000559] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 11/18/2019] [Indexed: 11/25/2022] Open
Abstract
The global rise in obesity and steady decline in sperm quality are two alarming trends that have emerged during recent decades. In parallel, evidence from model organisms shows that paternal diet can affect offspring metabolic health in a process involving sperm tRNA-derived small RNA (tsRNA). Here, we report that human sperm are acutely sensitive to nutrient flux, both in terms of sperm motility and changes in sperm tsRNA. Over the course of a 2-week diet intervention, in which we first introduced a healthy diet followed by a diet rich in sugar, sperm motility increased and stabilized at high levels. Small RNA-seq on repeatedly sampled sperm from the same individuals revealed that tsRNAs were up-regulated by eating a high-sugar diet for just 1 week. Unsupervised clustering identified two independent pathways for the biogenesis of these tsRNAs: one involving a novel class of fragments with specific cleavage in the T-loop of mature nuclear tRNAs and the other exclusively involving mitochondrial tsRNAs. Mitochondrial involvement was further supported by a similar up-regulation of mitochondrial rRNA-derived small RNA (rsRNA). Notably, the changes in sugar-sensitive tsRNA were positively associated with simultaneous changes in sperm motility and negatively associated with obesity in an independent clinical cohort. This rapid response to a dietary intervention on tsRNA in human sperm is attuned with the paternal intergenerational metabolic responses found in model organisms. More importantly, our findings suggest shared diet-sensitive mechanisms between sperm motility and the biogenesis of tsRNA, which provide novel insights about the interplay between nutrition and male reproductive health.
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Affiliation(s)
- Daniel Nätt
- Linköping University, Department of Clinical and Experimental Medicine, Division of Neurobiology, Linkoping, Sweden
| | - Unn Kugelberg
- Linköping University, Department of Clinical and Experimental Medicine, Division of Neurobiology, Linkoping, Sweden
| | - Eduard Casas
- Josep Carreras Leukaemia Research Institute (IJC), Program for Predictive and Personalized Medicine of Cancer (PMPPC-IGTP), Barcelona, Spain
| | - Elizabeth Nedstrand
- Linköping University, Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, Linköping, Sweden
| | - Stefan Zalavary
- Linköping University, Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, Linköping, Sweden
| | - Pontus Henriksson
- Karolinska Institute, Department of Biosciences and Nutrition, Huddinge, Sweden
- Linköping University, Department of Medical and Health Sciences, Division of Community Medicine, Linköping, Sweden
| | - Carola Nijm
- Linköping University, Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, Linköping, Sweden
| | - Julia Jäderquist
- Linköping University, Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, Linköping, Sweden
| | - Johanna Sandborg
- Karolinska Institute, Department of Biosciences and Nutrition, Huddinge, Sweden
- Linköping University, Department of Medical and Health Sciences, Division of Community Medicine, Linköping, Sweden
| | - Eva Flinke
- Linköping University, Department of Medical and Health Sciences, Division of Community Medicine, Linköping, Sweden
| | - Rashmi Ramesh
- Linköping University, Department of Clinical and Experimental Medicine, Division of Neurobiology, Linkoping, Sweden
| | - Lovisa Örkenby
- Linköping University, Department of Clinical and Experimental Medicine, Division of Neurobiology, Linkoping, Sweden
| | - Filip Appelkvist
- Linköping University, Department of Clinical and Experimental Medicine, Division of Neurobiology, Linkoping, Sweden
| | - Thomas Lingg
- Linköping University, Department of Clinical and Experimental Medicine, Division of Neurobiology, Linkoping, Sweden
| | - Nicola Guzzi
- Lund University, Stem Cell Center, Department of Laboratory Medicine, Division of Molecular Hematology, Lund, Sweden
| | - Cristian Bellodi
- Lund University, Stem Cell Center, Department of Laboratory Medicine, Division of Molecular Hematology, Lund, Sweden
| | - Marie Löf
- Karolinska Institute, Department of Biosciences and Nutrition, Huddinge, Sweden
- Linköping University, Department of Medical and Health Sciences, Division of Community Medicine, Linköping, Sweden
| | - Tanya Vavouri
- Josep Carreras Leukaemia Research Institute (IJC), Program for Predictive and Personalized Medicine of Cancer (PMPPC-IGTP), Barcelona, Spain
| | - Anita Öst
- Linköping University, Department of Clinical and Experimental Medicine, Division of Neurobiology, Linkoping, Sweden
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Salih Joelsson L, Elenis E, Wanggren K, Berglund A, Iliadou AN, Cesta CE, Mumford SL, White R, Tydén T, Skalkidou A. Investigating the effect of lifestyle risk factors upon number of aspirated and mature oocytes in in vitro fertilization cycles: Interaction with antral follicle count. PLoS One 2019; 14:e0221015. [PMID: 31419245 PMCID: PMC6697332 DOI: 10.1371/journal.pone.0221015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 07/30/2019] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION There is evidence demonstrating that certain lifestyle factors have a detrimental effect on fertility. Since such factors often coexist, possible synergistic effects merit further investigation. Thus we aimed to examine the cumulative impact of lifestyle factors on in vitro fertilization (IVF) early reproductive treatment outcomes and their interaction with measures of ovarian reserve. MATERIALS AND METHODS By following women who were starting their first fresh IVF cycle in 2 cohorts, the "Lifestyle study cohort" (hypothesis generating cohort, n = 242) and the "UppSTART study" (validation cohort, n = 432) in Sweden, we identified two significant risk factors acting independently, smoking and BMI, and then further assessed their cumulative effects. RESULTS Women with both these risk factors had an Incidence Rate Ratio (IRR) of 0.75 [(95% CI 0.61-0.94)] regarding the number of aspirated oocytes compared to women without these risk factors. Concerning the proportion of mature oocytes in relation to the total number of aspirated oocytes, the interaction between BMI and Antral Follicle Count (AFC) was significant (p-value 0.045): the lower the value of AFC, the more harmful the effect of BMI with the outcome. CONCLUSIONS Data shows that there is an individual as well as a cumulative effect of smoking and BMI on the number of aspirated and mature oocytes in fresh IVF treatment cycles. AFC might modify associations between BMI and the proportion of mature oocytes in relation to the total number of aspirated oocytes. These results highlight the importance of lifestyle factors on IVF early reproductive outcomes and provide additional evidence for the importance of preconception guidance for the optimization of IVF cycle outcome.
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Affiliation(s)
- Lana Salih Joelsson
- Institute of Women’s and Children’s, Obstetrics and Gynecology, Uppsala University, Uppsala, Sweden
| | - Evangelia Elenis
- Institute of Women’s and Children’s, Obstetrics and Gynecology, Uppsala University, Uppsala, Sweden
| | - Kjell Wanggren
- Department of Clinical Science, Intervention and Technology, Obstetrics and gynecology, Karolinska Institute, Stockholm, Sweden
| | - Anna Berglund
- National Centre for Knowledge on Men's Violence against women (NCK), Uppsala University, Uppsala, Sweden
| | - Anastasia N. Iliadou
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Carolyn E. Cesta
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Sunni L. Mumford
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, United States of America
| | | | - Tanja Tydén
- Institute of Women’s and Children’s, Obstetrics and Gynecology, Uppsala University, Uppsala, Sweden
| | - Alkistis Skalkidou
- Institute of Women’s and Children’s, Obstetrics and Gynecology, Uppsala University, Uppsala, Sweden
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Luckett DJ, Laber EB, Kahkoska AR, Maahs DM, Mayer-Davis E, Kosorok MR. Estimating Dynamic Treatment Regimes in Mobile Health Using V-learning. J Am Stat Assoc 2019; 115:692-706. [PMID: 32952236 DOI: 10.1080/01621459.2018.1537919] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The vision for precision medicine is to use individual patient characteristics to inform a personalized treatment plan that leads to the best possible health-care for each patient. Mobile technologies have an important role to play in this vision as they offer a means to monitor a patient's health status in real-time and subsequently to deliver interventions if, when, and in the dose that they are needed. Dynamic treatment regimes formalize individualized treatment plans as sequences of decision rules, one per stage of clinical intervention, that map current patient information to a recommended treatment. However, most existing methods for estimating optimal dynamic treatment regimes are designed for a small number of fixed decision points occurring on a coarse time-scale. We propose a new reinforcement learning method for estimating an optimal treatment regime that is applicable to data collected using mobile technologies in an out-patient setting. The proposed method accommodates an indefinite time horizon and minute-by-minute decision making that are common in mobile health applications. We show that the proposed estimators are consistent and asymptotically normal under mild conditions. The proposed methods are applied to estimate an optimal dynamic treatment regime for controlling blood glucose levels in patients with type 1 diabetes.
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Affiliation(s)
- Daniel J Luckett
- Department of Biostatistics, University of North Carolina at Chapel Hill
| | - Eric B Laber
- Department of Statistics, North Carolina State University
| | - Anna R Kahkoska
- Department of Nutrition, University of North Carolina at Chapel Hill
| | | | | | - Michael R Kosorok
- Department of Biostatistics, University of North Carolina at Chapel Hill
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Henriksson P, Sandborg J, Blomberg M, Alexandrou C, Maddison R, Silfvernagel K, Henriksson H, Leppänen MH, Migueles JH, Widman L, Thomas K, Trolle Lagerros Y, Löf M. A Smartphone App to Promote Healthy Weight Gain, Diet, and Physical Activity During Pregnancy (HealthyMoms): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e13011. [PMID: 30821695 PMCID: PMC6418485 DOI: 10.2196/13011] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/16/2019] [Accepted: 01/18/2019] [Indexed: 01/20/2023] Open
Abstract
Background Excessive gestational weight gain is common and associated with adverse outcomes both in the short and long term. Although traditional lifestyle-based interventions have shown to mitigate excess gestational weight gain, little is known about whether mobile Health (mHealth) apps can promote healthy weight gain, diet, and physical activity during pregnancy. Objective The primary aim of the HealthyMoms trial is to determine the effectiveness of a smartphone app (HealthyMoms) for mitigating excess gestational weight gain during pregnancy. Secondary aims are to determine the effectiveness of the app on dietary habits, physical activity, body fatness, and glycemia during pregnancy. Methods HealthyMoms is a two-arm randomized controlled trial. Women are being recruited at routine visits at the maternity clinics in Linköping, Norrköping and Motala, Sweden. Women are randomized to the control or intervention group (n=150 per group). All women will receive standard care, and women in the intervention group will also receive the HealthyMoms smartphone app. Results Recruitment of participants to the trial was initiated in October 2017, and 190 women have so far completed the baseline measurement. The baseline measures are estimated to be finalized in December 2019, and the follow-up measures are estimated to be completed in June 2020. Conclusions This project will evaluate a novel smartphone app intervention integrated with existing maternity health care. If successful, it has great potential to be implemented nationally in order to promote healthy weight gain and health behaviors during pregnancy. International Registered Report Identifier (IRRID) DERR1-10.2196/13011
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Affiliation(s)
- Pontus Henriksson
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden.,Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Johanna Sandborg
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden.,Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Marie Blomberg
- Department of Obstetrics and Gynecology, Linköping University, Linköping, Sweden.,Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Christina Alexandrou
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | - Kristin Silfvernagel
- Division of Psychology, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Hanna Henriksson
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Marja H Leppänen
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden.,Faculty of Sport and Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland
| | - Jairo H Migueles
- Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Linnea Widman
- Department of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kristin Thomas
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ylva Trolle Lagerros
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Solna, Sweden.,Obesity Center, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - Marie Löf
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden.,Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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15
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de Korte E, Wiezer N, Bakhuys Roozeboom M, Vink P, Kraaij W. Behavior Change Techniques in mHealth Apps for the Mental and Physical Health of Employees: Systematic Assessment. JMIR Mhealth Uhealth 2018; 6:e167. [PMID: 30282621 PMCID: PMC6231882 DOI: 10.2196/mhealth.6363] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 12/28/2017] [Accepted: 07/10/2018] [Indexed: 11/28/2022] Open
Abstract
Background Employees remain at risk of developing physical and mental health problems. To improve the lifestyle, health, and productivity many workplace interventions have been developed. However, not all of these interventions are effective. Mobile and wireless technology to support health behavior change (mobile health [mHealth] apps) is a promising, but relatively new domain for the occupational setting. Research on mHealth apps for the mental and physical health of employees is scarce. Interventions are more likely to be useful if they are rooted in health behavior change theory. Evaluating the presence of specific combinations of behavior change techniques (BCTs) in mHealth apps might be used as an indicator of potential quality and effectiveness. Objective The aim of this study was to assess whether mHealth apps for the mental and physical health of employees incorporate BCTs and, if so, which BCTs can be identified and which combinations of BCTs are present. Methods An assessment was made of apps aiming to reduce the risk of physical and psychosocial work demands and to promote a healthy lifestyle for employees. A systematic search was performed in iTunes and Google Play. Forty-five apps were screened and downloaded. BCTs were identified using a taxonomy applied in similar reviews. The mean and ranges were calculated. Results On average, the apps included 7 of the 26 BCTs (range 2-18). Techniques such as “provide feedback on performance,” “provide information about behavior-health link,” and “provide instruction” were used most frequently. Techniques that were used least were “relapse prevention,” “prompt self-talk,” “use follow-up prompts,” and “provide information about others’ approval.” “Stress management,” “prompt identification as a role model,” and “agree on behavioral contract” were not used by any of the apps. The combination “provide information about behavior-health link” with “prompt intention formation” was found in 7/45 (16%) apps. The combination “provide information about behavior-health link” with “provide information on consequences,” and “use follow-up prompts” was found in 2 (4%) apps. These combinations indicated potential effectiveness. The least potentially effective combination “provide feedback on performance” without “provide instruction” was found in 13 (29%) apps. Conclusions Apps for the occupational setting might be substantially improved to increase potential since results showed a limited presence of BCTs in general, limited use of potentially successful combinations of BCTs in apps, and use of potentially unsuccessful combinations of BCTs. Increasing knowledge on the effectiveness of BCTs in apps might be used to develop guidelines for app developers and selection criteria for companies and individuals. Also, this might contribute to decreasing the burden of work-related diseases. To achieve this, app developers, health behavior change professionals, experts on physical and mental health, and end-users should collaborate when developing apps for the working context.
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Affiliation(s)
- Elsbeth de Korte
- Netherlands Organization for Applied Scientific Research, Leiden, Netherlands.,Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Noortje Wiezer
- Netherlands Organization for Applied Scientific Research, Leiden, Netherlands
| | | | - Peter Vink
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Wessel Kraaij
- Netherlands Organization for Applied Scientific Research, Leiden, Netherlands.,Leiden Institute of Advanced Computer Science, Faculty of Science, Leiden University, Leiden, Netherlands
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16
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Ek A, Alexandrou C, Delisle Nyström C, Direito A, Eriksson U, Hammar U, Henriksson P, Maddison R, Trolle Lagerros Y, Löf M. The Smart City Active Mobile Phone Intervention (SCAMPI) study to promote physical activity through active transportation in healthy adults: a study protocol for a randomised controlled trial. BMC Public Health 2018; 18:880. [PMID: 30012116 PMCID: PMC6048804 DOI: 10.1186/s12889-018-5658-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/01/2018] [Indexed: 11/10/2022] Open
Abstract
Background The global pandemic of physical inactivity represents a considerable public health challenge. Active transportation (i.e., walking or cycling for transport) can contribute to greater total physical activity levels. Mobile phone-based programs can promote behaviour change, but no study has evaluated whether such a program can promote active transportation in adults. This study protocol presents the design and methodology of The Smart City Active Mobile Phone Intervention (SCAMPI), a randomised controlled trial to promote active transportation via a smartphone application (app) with the aim to increase physical activity. Methods/design A two-arm parallel randomised controlled trial will be conducted in Stockholm County, Sweden. Two hundred fifty adults aged 20–65 years will be randomised to either monitoring of active transport via the TRavelVU app (control), or to a 3-month evidence-based behaviour change program to promote active transport and monitoring of active travel via the TRavelVU Plus app (intervention). The primary outcome is moderate-to-vigorous intensity physical activity (MVPA in minutes/day) (ActiGraph wGT3x-BT) measured post intervention. Secondary outcomes include: time spent in active transportation measured via the TRavelVU app, perceptions about active transportation (the Transport and Physical Activity Questionnaire (TPAQ)) and health related quality of life (RAND-36). Assessments are conducted at baseline, after the completed intervention (after 3 months) and 6 months post randomisation. Discussion SCAMPI will determine the effectiveness of a smartphone app to promote active transportation and physical activity in an adult population. If effective, the app has potential to be a low-cost intervention that can be delivered at scale. Trial registration ClinicalTrials.gov NCT03086837; 22 March, 2017.
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Affiliation(s)
- Anna Ek
- Department of Biosciences and Nutrition, Karolinska Institutet, Group MLÖ, 141 83, Huddinge, Sweden.
| | - Christina Alexandrou
- Department of Biosciences and Nutrition, Karolinska Institutet, Group MLÖ, 141 83, Huddinge, Sweden
| | - Christine Delisle Nyström
- Department of Biosciences and Nutrition, Karolinska Institutet, Group MLÖ, 141 83, Huddinge, Sweden.,Healthy Active Living and Obesity (HALO) Research Group, Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Artur Direito
- Centre for Behaviour Change, University College London, Alexandra House, 17-19 Queen Square, London, WC1N 3AR, UK
| | - Ulf Eriksson
- Trivector Traffic, Barnhusgatan 16, 111 23, Stockholm, Sweden
| | - Ulf Hammar
- Institute of Environmental Medicine, C6, Biostatistics, Karolinska Institutet, 210, 171 77, Stockholm, PO, Sweden
| | - Pontus Henriksson
- Department of Biosciences and Nutrition, Karolinska Institutet, Group MLÖ, 141 83, Huddinge, Sweden
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Melbourne, VIC, 3125, Australia
| | - Ylva Trolle Lagerros
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Eugeniahemmet T2, 171 76, Stockholm, Sweden.,Clinic of Endocrinology, Metabolism and Diabetes, Department of Medicine, Karolinska University Hospital, 141 86, Huddinge, Sweden
| | - Marie Löf
- Department of Biosciences and Nutrition, Karolinska Institutet, Group MLÖ, 141 83, Huddinge, Sweden
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17
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Forsum E, Janerot-Sjöberg B, Löf M. MET-values of standardised activities in relation to body fat: studies in pregnant and non-pregnant women. Nutr Metab (Lond) 2018; 15:45. [PMID: 29951109 PMCID: PMC6011259 DOI: 10.1186/s12986-018-0281-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 06/04/2018] [Indexed: 11/10/2022] Open
Abstract
Background Physical activity is associated with health in women. Published MET-values (MET: metabolic equivalent of task) may assess physical activity and energy expenditure but tend to be too low for subjects with a high total body fat (TBF) content and therefore inappropriate for many contemporary women. The MET-value for an activity is the energy expenditure of a subject performing this activity divided by his/her resting energy expenditure, often assumed to be 4.2 kJ/kg/h. Relationships between TBF and MET have been little studied although overweight and obesity is common in women. Available data indicate that MET-values decrease during pregnancy but more studies in pregnant contemporary women are needed. Subjects and methods Using indirect calorimetry we measured energy expenditure and assessed MET-values in women, 22 non-pregnant (BMI: 18–34) and 22 in gestational week 32 (non-pregnant BMI: 18–32) when resting, sitting, cycling (30 and 60 watts), walking (3.2 and 5.6 km/h) and running (8 km/h). Relationships between TBF and MET-values were investigated and used to predict modified MET-values. The potential of such values to improve calculations of total energy expenditure of women was investigated. Results The resting energy expenditure was below 4.2 kJ/kg/h in both groups of women. Women in gestational week 32 had a higher resting energy metabolism (p < 0.001) and 7–15% lower MET-values (p < 0.05) than non-pregnant women. MET-values of all activities were correlated with TBF (p < 0.05) in non-pregnant women and modified MET-values improved estimates of total energy expenditure in such women. In pregnant women, correlations (p ≤ 0.03) between TBF and MET were found for running (8 km/h) and for walking at 5.6 km/h. Conclusions Our results are relevant when attempts are made to modify the MET-system in contemporary pregnant and non-pregnant women. MET-values were decreased in gestational week 32, mainly due to an increased resting energy metabolism and studies describing how body composition affects the one MET-value (i.e. the resting energy metabolism in kJ/kg/h) during pregnancy are warranted. Studies of how pregnancy and TBF affect MET-values of high intensity activities are also needed. Corrections based on TBF may have a potential to improve the MET-system in non-pregnant women.
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Affiliation(s)
- Elisabet Forsum
- 1Department of Clinical and Experimental Medicine, Linköping University, 581 85 Linköping, SE Sweden
| | - Birgitta Janerot-Sjöberg
- 2Division of Cardiovascular Medicine, Department of Medical and Health Science, Linköping University, Linköping, Sweden.,3Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.,4Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Marie Löf
- 5Department of Biosciences and Nutrition, Karolinska Institute, Huddinge, Sweden.,6Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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18
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de Korte EM, Wiezer N, Janssen JH, Vink P, Kraaij W. Evaluating an mHealth App for Health and Well-Being at Work: Mixed-Method Qualitative Study. JMIR Mhealth Uhealth 2018; 6:e72. [PMID: 29592846 PMCID: PMC5895922 DOI: 10.2196/mhealth.6335] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 07/24/2017] [Accepted: 07/27/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To improve workers' health and well-being, workplace interventions have been developed, but utilization and reach are unsatisfactory, and effects are small. In recent years, new approaches such as mobile health (mHealth) apps are being developed, but the evidence base is poor. Research is needed to examine its potential and to assess when, where, and for whom mHealth is efficacious in the occupational setting. To develop interventions for workers that actually will be adopted, insight into user satisfaction and technology acceptance is necessary. For this purpose, various qualitative evaluation methods are available. OBJECTIVE The objectives of this study were to gain insight into (1) the opinions and experiences of employees and experts on drivers and barriers using an mHealth app in the working context and (2) the added value of three different qualitative methods that are available to evaluate mHealth apps in a working context: interviews with employees, focus groups with employees, and a focus group with experts. METHODS Employees of a high-tech company and experts were asked to use an mHealth app for at least 3 weeks before participating in a qualitative evaluation. Twenty-two employees participated in interviews, 15 employees participated in three focus groups, and 6 experts participated in one focus group. Two researchers independently coded, categorized, and analyzed all quotes yielded from these evaluation methods with a codebook using constructs from user satisfaction and technology acceptance theories. RESULTS Interviewing employees yielded 785 quotes, focus groups with employees yielded 266 quotes, and the focus group with experts yielded 132 quotes. Overall, participants muted enthusiasm about the app. Combined results from the three evaluation methods showed drivers and barriers for technology, user characteristics, context, privacy, and autonomy. A comparison between the three qualitative methods showed that issues revealed by experts only slightly overlapped with those expressed by employees. In addition, it was seen that the type of evaluation yielded different results. CONCLUSIONS Findings from this study provide the following recommendations for organizations that are planning to provide mHealth apps to their workers and for developers of mHealth apps: (1) system performance influences adoption and adherence, (2) relevancy and benefits of the mHealth app should be clear to the user and should address users' characteristics, (3) app should take into account the work context, and (4) employees should be alerted to their right to privacy and use of personal data. Furthermore, a qualitative evaluation of mHealth apps in a work setting might benefit from combining more than one method. Factors to consider when selecting a qualitative research method are the design, development stage, and implementation of the app; the working context in which it is being used; employees' mental models; practicability; resources; and skills required of experts and users.
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Affiliation(s)
- Elsbeth Marieke de Korte
- Netherlands Organisation for Applied Scientific Research, Leiden, Netherlands.,Faculty Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Noortje Wiezer
- Netherlands Organisation for Applied Scientific Research, Leiden, Netherlands
| | | | - Peter Vink
- Faculty Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Wessel Kraaij
- Netherlands Organisation for Applied Scientific Research, Den Haag, Netherlands.,Faculty of Science, Leiden Institute of Advanced Computer Science, Leiden University, Leiden, Netherlands
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Cesta CE, Johansson AL, Hreinsson J, Rodriguez-Wallberg KA, Olofsson JI, Holte J, Wramsby H, Wramsby M, Cnattingius S, Skalkidou A, Nyman Iliadou A. A prospective investigation of perceived stress, infertility-related stress, and cortisol levels in women undergoing in vitro fertilization: influence on embryo quality and clinical pregnancy rate. Acta Obstet Gynecol Scand 2018; 97:258-268. [DOI: 10.1111/aogs.13280] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 12/09/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Carolyn E. Cesta
- Department of Medical Epidemiology and Biostatistics; Karolinska Institute; Stockholm Sweden
| | - Anna L.V. Johansson
- Department of Medical Epidemiology and Biostatistics; Karolinska Institute; Stockholm Sweden
| | - Julius Hreinsson
- Reproductive Medicine; Department of Obstetrics and Gynecology; Karolinska University Hospital; Stockholm Sweden
| | - Kenny A. Rodriguez-Wallberg
- Reproductive Medicine; Department of Obstetrics and Gynecology; Karolinska University Hospital; Stockholm Sweden
- Department of Oncology-Pathology; Karolinska Institute; Stockholm Sweden
| | - Jan I. Olofsson
- Reproductive Medicine; Department of Obstetrics and Gynecology; Karolinska University Hospital; Stockholm Sweden
- Department of Women's and Children's Health; Karolinska Institute; Stockholm Sweden
| | - Jan Holte
- Carl von Linné Clinic; Uppsala Sweden
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
- Center for Reproductive Biology in Uppsala; University of Agricultural Sciences and Uppsala University; Uppsala Sweden
| | - Håkan Wramsby
- IVF-kliniken Stockholm, S:t Görans sjukhus; Stockholm Sweden
| | | | - Sven Cnattingius
- Clinical Epidemiology Unit; Department of Medicine Solna; Karolinska Institute; Stockholm Sweden
| | - Alkistis Skalkidou
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - Anastasia Nyman Iliadou
- Department of Medical Epidemiology and Biostatistics; Karolinska Institute; Stockholm Sweden
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20
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Ghilotti F, Pesonen AS, Raposo SE, Winell H, Nyrén O, Trolle Lagerros Y, Plymoth A. Physical activity, sleep and risk of respiratory infections: A Swedish cohort study. PLoS One 2018; 13:e0190270. [PMID: 29300730 PMCID: PMC5754073 DOI: 10.1371/journal.pone.0190270] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 11/20/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Previous studies found higher levels of physical activity to be protective against infections and that short and long sleep negatively affects the immune response. However, these relationships remain debatable. We aimed to investigate if physical activity and sleep habits affect incidence of upper respiratory tract infections (URTI) in a prospective cohort study. METHODS A total of 2,038 adults aged 25-64 years served as a random sample of the gainfully employed population of an industrial town in Sweden. Physical activity and sleep habits were estimated through self-reported questionnaires. Physical activity was expressed as metabolic energy turnover hours per day. Sleep was assessed as number of hours slept per night and its perceived quality. URTI outcome was prospectively self-reported during a 9-month follow-up period. Associations of physical activity and sleep with URTI were estimated using hurdle regression models adjusted for potential confounders. RESULTS During 1,583 person-years 1,597 URTI occurred, resulting in an incidence of 1.01 infections/person-year (95% CI 0.96-1.06). The fitted regression models did not provide support for an association with physical activity or sleep habits. Factors positively associated with experiencing URTI were having children ≤ 6 years, female gender, higher education and treatment for allergy, asthma or lung cancer. Having children ≤ 6 years and female gender were related to a higher number of URTI among those experiencing URTI. CONCLUSIONS We did not find any association between physical activity, sleep duration or sleep quality and the occurrence of upper respiratory tract infections in adult Swedish population.
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Affiliation(s)
- Francesca Ghilotti
- Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
- * E-mail:
| | - Ann-Sofie Pesonen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sara E. Raposo
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Henric Winell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Statistics, Uppsala University, Uppsala, Sweden
| | - Olof Nyrén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ylva Trolle Lagerros
- Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine, Clinic of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Amelie Plymoth
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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21
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Helbostad JL, Vereijken B, Becker C, Todd C, Taraldsen K, Pijnappels M, Aminian K, Mellone S. Mobile Health Applications to Promote Active and Healthy Ageing. SENSORS 2017; 17:s17030622. [PMID: 28335475 PMCID: PMC5375908 DOI: 10.3390/s17030622] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 03/14/2017] [Accepted: 03/15/2017] [Indexed: 11/16/2022]
Abstract
The European population is ageing, and there is a need for health solutions that keep older adults independent longer. With increasing access to mobile technology, such as smartphones and smartwatches, the development and use of mobile health applications is rapidly growing. To meet the societal challenge of changing demography, mobile health solutions are warranted that support older adults to stay healthy and active and that can prevent or delay functional decline. This paper reviews the literature on mobile technology, in particular wearable technology, such as smartphones, smartwatches, and wristbands, presenting new ideas on how this technology can be used to encourage an active lifestyle, and discusses the way forward in order further to advance development and practice in the field of mobile technology for active, healthy ageing.
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Affiliation(s)
- Jorunn L Helbostad
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway.
| | - Beatrix Vereijken
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway.
| | - Clemens Becker
- Robert Bosch Foundation for Medical Research, 70184 Stuttgart, Germany.
| | - Chris Todd
- School of Health Sciences, University of Manchester, and South Manchester University Hospital NHS Trust, and Manchester Academic Health Sciences Centre, Manchester M13 9PL, UK.
| | - Kristin Taraldsen
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway.
| | - Mirjam Pijnappels
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, 1081BT Amsterdam, The Netherlands.
| | - Kamiar Aminian
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Federale de Lausanne, 1015 Lausanne, Switzerland.
| | - Sabato Mellone
- Department of Electrical, Electronic and Information Engineering, University of Bologna, 40126 Bologna, Italy.
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22
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Lind J, Kälvemark Sporrong S, Kaae S, Rantanen J, Genina N. Social aspects in additive manufacturing of pharmaceutical products. Expert Opin Drug Deliv 2016; 14:927-936. [PMID: 27892721 DOI: 10.1080/17425247.2017.1266336] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Additive manufacturing (AM) techniques, such as drug printing, represent a new engineering approach that can implement the concept of personalized medicine via on-demand manufacturing of dosage forms with individually adjusted doses. Implementation of AM principles, such as pharmacoprinting, will challenge the entire drug distribution chain and affect the society at different levels. Areas covered: This work summarizes the concept of personalized medicine and gives an overview of possibilities for monitoring patients' health. The most recent activities in the field of printing technologies for fabrication of dosage forms and 'polypills' with flexible doses and tailored release profiles are reviewed. Different scenarios for the drug distribution chain with the required adjustments in drug logistics, quality systems and environmental safety are discussed, as well as whether AM will be used for production of on-demand medicine. The impact of such changes in the distribution chain on regulation, healthcare professionals and patients are highlighted. Expert opinion: Drug manufacturing by traditional methods is well-established, but it lacks the possibility for on-demand personalized drug production. With the recent approval of the first printed medicine, society should be prepared for the changes that will follow the introduction of printed pharmaceuticals.
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Affiliation(s)
- Johanna Lind
- a Department of Pharmacy , University of Copenhagen , Copenhagen , Denmark
| | | | - Susanne Kaae
- a Department of Pharmacy , University of Copenhagen , Copenhagen , Denmark
| | - Jukka Rantanen
- a Department of Pharmacy , University of Copenhagen , Copenhagen , Denmark
| | - Natalja Genina
- a Department of Pharmacy , University of Copenhagen , Copenhagen , Denmark
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Food intake and gestational weight gain in Swedish women. SPRINGERPLUS 2016; 5:377. [PMID: 27066384 PMCID: PMC4811841 DOI: 10.1186/s40064-016-2015-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 03/16/2016] [Indexed: 12/02/2022]
Abstract
Background The objective of this study was to investigate if food intake (dairy, snacks, caloric beverages, bread, cheese, margarine/butter, potato/rice/pasta/grains, red meat, fish and fruit/berries/vegetables) is associated with gestational weight gain (GWG) in Swedish women. Methods Four day food records from 95 pregnant Swedish women were collected in the last trimester. GWG was calculated as weighed body weight in the last trimester (median gestational week 36) minus self-reported pre-pregnancy body weight. Excessive GWG was defined according to the guidelines by the Institute of Medicine. Food groups tested for association with GWG were dairy (milk, yoghurt and sour milk), snacks (sweets, crisps, popcorn, ice cream and cookies, but not nuts and seeds), caloric beverages (soft drinks, juice, lemonade and non-alcoholic beer), bread, cheese, margarine/butter, potato/rice/pasta/grains, red meat, fish and fruit/berries/vegetables. Results Median (lower–upper quartiles) GWG was 12.1 kg (10.0–15.3). In total, 28 % had an excessive GWG. Excessive GWG was most common among pre-pregnancy overweight and obese women, where 69 % had an excessive GWG. Median daily intake of fruits and vegetables was 352 g (212–453), caloric beverages was 238 g (100–420) and snacks was 111 g (69–115). Multivariable linear regression analysis showed that intake of caloric beverages, snacks, fish, bread and dairy in the last trimester of pregnancy were positively related to GWG (R2 = 0.32). Multivariable logistic regression analysis showed that intake of caloric beverages, snacks, fish, and bread was associated with higher odds ratios for excessive GWG. Conclusion Intake of caloric beverages, snacks, fish and bread were positively related to excessive GWG. Thus, these results indicate that maternal dietary intake should be given higher attention in the antenatal care.
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Svensson Å, Larsson C. A Mobile Phone App for Dietary Intake Assessment in Adolescents: An Evaluation Study. JMIR Mhealth Uhealth 2015; 3:e93. [PMID: 26534783 PMCID: PMC4704917 DOI: 10.2196/mhealth.4804] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/18/2015] [Accepted: 09/02/2015] [Indexed: 12/05/2022] Open
Abstract
Background There is a great need for dietary assessment methods that suit the adolescent lifestyle and give valid intake data. Objective To develop a mobile phone app and evaluate its ability to assess energy intake (EI) and total energy expenditure (TEE) compared with objectively measured TEE. Furthermore, to investigate the impact of factors on reporting accuracy of EI, and to compare dietary intake with a Web-based method. Methods Participants 14 to 16 years of age were recruited from year nine in schools in Gothenburg, Sweden. In total, 81 adolescents used the mobile phone app over 1 to 6 days. TEE was measured with the SenseWear Armband (SWA) during the same or proximate days. Individual factors were assessed with a questionnaire. A total of 15 participants also recorded dietary intake using a Web-based method. Results The mobile phone app underestimated EI by 29% on a group level (P<.001) compared to TEE measured with the SWA, and there was no significant correlation between EI and TEE. Accuracy of EI relative to TEE increased with a weekend day in the record (P=.007) and lower BMI z-score (P=.001). TEE assessed with the mobile phone app was 1.19 times the value of TEE measured by the SWA on a group level (P<.001), and the correlation between the methods was .75 (P<.001). Analysis of physical activity levels (PAL) from the mobile phone app stratified by gender showed that accuracy of the mobile phone app was higher among boys. EI, nutrients, and food groups assessed with the mobile phone app and Web-based method among 15 participants were not significantly different and several were significantly correlated, but strong conclusions cannot be drawn due to the low number of participants. Conclusions By using a mobile phone dietary assessment app, on average 71% of adolescents’ EI was captured. The accuracy of reported dietary intake was higher with lower BMI z-score and if a weekend day was included in the record. The daily question in the mobile phone app about physical activity could accurately rank the participants’ TEE.
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Affiliation(s)
- Åsa Svensson
- Department of Food and Nutrition, Umeå University, Umeå, Sweden
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Marcano Belisario JS, Jamsek J, Huckvale K, O'Donoghue J, Morrison CP, Car J. Comparison of self-administered survey questionnaire responses collected using mobile apps versus other methods. Cochrane Database Syst Rev 2015; 2015:MR000042. [PMID: 26212714 PMCID: PMC8152947 DOI: 10.1002/14651858.mr000042.pub2] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Self-administered survey questionnaires are an important data collection tool in clinical practice, public health research and epidemiology. They are ideal for achieving a wide geographic coverage of the target population, dealing with sensitive topics and are less resource-intensive than other data collection methods. These survey questionnaires can be delivered electronically, which can maximise the scalability and speed of data collection while reducing cost. In recent years, the use of apps running on consumer smart devices (i.e., smartphones and tablets) for this purpose has received considerable attention. However, variation in the mode of delivering a survey questionnaire could affect the quality of the responses collected. OBJECTIVES To assess the impact that smartphone and tablet apps as a delivery mode have on the quality of survey questionnaire responses compared to any other alternative delivery mode: paper, laptop computer, tablet computer (manufactured before 2007), short message service (SMS) and plastic objects. SEARCH METHODS We searched MEDLINE, EMBASE, PsycINFO, IEEEXplore, Web of Science, CABI: CAB Abstracts, Current Contents Connect, ACM Digital, ERIC, Sociological Abstracts, Health Management Information Consortium, the Campbell Library and CENTRAL. We also searched registers of current and ongoing clinical trials such as ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform. We also searched the grey literature in OpenGrey, Mobile Active and ProQuest Dissertation & Theses. Lastly, we searched Google Scholar and the reference lists of included studies and relevant systematic reviews. We performed all searches up to 12 and 13 April 2015. SELECTION CRITERIA We included parallel randomised controlled trials (RCTs), crossover trials and paired repeated measures studies that compared the electronic delivery of self-administered survey questionnaires via a smartphone or tablet app with any other delivery mode. We included data obtained from participants completing health-related self-administered survey questionnaire, both validated and non-validated. We also included data offered by both healthy volunteers and by those with any clinical diagnosis. We included studies that reported any of the following outcomes: data equivalence; data accuracy; data completeness; response rates; differences in the time taken to complete a survey questionnaire; differences in respondent's adherence to the original sampling protocol; and acceptability to respondents of the delivery mode. We included studies that were published in 2007 or after, as devices that became available during this time are compatible with the mobile operating system (OS) framework that focuses on apps. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data from the included studies using a standardised form created for this systematic review in REDCap. They then compared their forms to reach consensus. Through an initial systematic mapping on the included studies, we identified two settings in which survey completion took place: controlled and uncontrolled. These settings differed in terms of (i) the location where surveys were completed, (ii) the frequency and intensity of sampling protocols, and (iii) the level of control over potential confounders (e.g., type of technology, level of help offered to respondents). We conducted a narrative synthesis of the evidence because a meta-analysis was not appropriate due to high levels of clinical and methodological diversity. We reported our findings for each outcome according to the setting in which the studies were conducted. MAIN RESULTS We included 14 studies (15 records) with a total of 2275 participants; although we included only 2272 participants in the final analyses as there were missing data for three participants from one included study.Regarding data equivalence, in both controlled and uncontrolled settings, the included studies found no significant differences in the mean overall scores between apps and other delivery modes, and that all correlation coefficients exceeded the recommended thresholds for data equivalence. Concerning the time taken to complete a survey questionnaire in a controlled setting, one study found that an app was faster than paper, whereas the other study did not find a significant difference between the two delivery modes. In an uncontrolled setting, one study found that an app was faster than SMS. Data completeness and adherence to sampling protocols were only reported in uncontrolled settings. Regarding the former, an app was found to result in more complete records than paper, and in significantly more data entries than an SMS-based survey questionnaire. Regarding adherence to the sampling protocol, apps may be better than paper but no different from SMS. We identified multiple definitions of acceptability to respondents, with inconclusive results: preference; ease of use; willingness to use a delivery mode; satisfaction; effectiveness of the system informativeness; perceived time taken to complete the survey questionnaire; perceived benefit of a delivery mode; perceived usefulness of a delivery mode; perceived ability to complete a survey questionnaire; maximum length of time that participants would be willing to use a delivery mode; and reactivity to the delivery mode and its successful integration into respondents' daily routine. Finally, regardless of the study setting, none of the included studies reported data accuracy or response rates. AUTHORS' CONCLUSIONS Our results, based on a narrative synthesis of the evidence, suggest that apps might not affect data equivalence as long as the intended clinical application of the survey questionnaire, its intended frequency of administration and the setting in which it was validated remain unchanged. There were no data on data accuracy or response rates, and findings on the time taken to complete a self-administered survey questionnaire were contradictory. Furthermore, although apps might improve data completeness, there is not enough evidence to assess their impact on adherence to sampling protocols. None of the included studies assessed how elements of user interaction design, survey questionnaire design and intervention design might influence mode effects. Those conducting research in public health and epidemiology should not assume that mode effects relevant to other delivery modes apply to apps running on consumer smart devices. Those conducting methodological research might wish to explore the issues highlighted by this systematic review.
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Affiliation(s)
- José S Marcano Belisario
- School of Public Health, Imperial College LondonGlobal eHealth Unit, Department of Primary Care and Public HealthLondonUK
| | - Jan Jamsek
- University of LjubljanaFaculty of MedicineVrazov trg 2LjubljanaSlovenia1000
| | - Kit Huckvale
- School of Public Health, Imperial College LondonGlobal eHealth Unit, Department of Primary Care and Public HealthLondonUK
| | - John O'Donoghue
- School of Public Health, Imperial College LondonDepartment of Primary Care and Public HealthRoom 326, The Reynolds BuildingSt Dunstans RoadLondonUKW6 8RP
| | - Cecily P Morrison
- School of Public Health, Imperial College LondonGlobal eHealth Unit, Department of Primary Care and Public HealthLondonUK
| | - Josip Car
- Imperial College & Nanyang Technological UniversityLee Kong Chian School of Medicine3 Fusionopolis Link, #03‐08Nexus@one‐northSingaporeSingapore138543
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Monroe CM, Thompson DL, Bassett DR, Fitzhugh EC, Raynor HA. Usability of Mobile Phones in Physical Activity–Related Research: A Systematic Review. AMERICAN JOURNAL OF HEALTH EDUCATION 2015. [DOI: 10.1080/19325037.2015.1044141] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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A prospective cohort study of the combined effects of physical activity and anthropometric measures on the risk of post-menopausal breast cancer. Eur J Epidemiol 2015; 31:395-404. [DOI: 10.1007/s10654-015-0064-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 06/18/2015] [Indexed: 12/30/2022]
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Knight-Agarwal C, Davis DL, Williams L, Davey R, Cox R, Clarke A. Development and Pilot Testing of the Eating4two Mobile Phone App to Monitor Gestational Weight Gain. JMIR Mhealth Uhealth 2015; 3:e44. [PMID: 26048313 PMCID: PMC4526903 DOI: 10.2196/mhealth.4071] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 03/10/2015] [Accepted: 03/14/2015] [Indexed: 02/02/2023] Open
Abstract
Background The number of pregnant women with a body mass index (BMI) of 30kg/m2 or more is increasing, which has important implications for antenatal care. Various resource-intensive interventions have attempted to assist women in managing their weight gain during pregnancy with limited success. A mobile phone app has been proposed as a convenient and cost-effective alternative to face-to-face interventions. Objective This paper describes the process of developing and pilot testing the Eating4Two app, which aims to provide women with a simple gestational weight gain (GWG) calculator, general dietary information, and the motivation to achieve a healthy weight gain during pregnancy. Methods The project involved the development of app components, including a graphing function that allows the user to record their weight throughout the pregnancy and to receive real-time feedback on weight gain progress and general information on antenatal nutrition. Stakeholder consultation was used to inform development. The app was pilot tested with 10 pregnant women using a mixed method approach via an online survey, 2 focus groups, and 1 individual interview. Results The Eating4Two app took 7 months to develop and evaluate. It involved several disciplines--including nutrition and dietetics, midwifery, public health, and information technology--at the University of Canberra. Participants found the Eating4Two app to be a motivational tool but would have liked scales or other markers on the graph that demonstrated exact weight gain. They also liked the nutrition information; however, many felt it should be formatted in a more user friendly way. Conclusions The Eating4Two app was viewed by participants in our study as an innovative support system to help motivate healthy behaviors during pregnancy and as a credible resource for accessing nutrition-focused information. The feedback provided by participants will assist with refining the current prototype for use in a clinical intervention trial.
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Namba H, Yamada Y, Ishida M, Takase H, Kimura M. Use of a Web-based physical activity record system to analyze behavior in a large population: cross-sectional study. J Med Internet Res 2015; 17:e74. [PMID: 25794109 PMCID: PMC4383835 DOI: 10.2196/jmir.3923] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 12/25/2014] [Accepted: 02/04/2015] [Indexed: 11/28/2022] Open
Abstract
Background The use of Web-based physical activity systems has been proposed as an easy method for collecting physical activity data. We have developed a system that has exhibited high accuracy as assessed by the doubly labeled water method. Objective The purpose of this study was to collect behavioral data from a large population using our Web-based physical activity record system and assess the physical activity of the population based on these data. In this paper, we address the difference in physical activity for each urban scale. Methods In total, 2046 participants (aged 30-59 years; 1105 men and 941 women) participated in the study. They were asked to complete data entry before bedtime using their personal computer on 1 weekday and 1 weekend day. Their residential information was categorized as urban, urban-rural, or rural. Participant responses expressed the intensity of each activity at 15-minute increments and were recorded on a Web server. Residential areas were compared and multiple regression analysis was performed. Results Most participants had a metabolic equivalent (MET) ranging from 1.4 to 1.8, and the mean MET was 1.60 (SD 0.28). The median value of moderate-to-vigorous physical activity (MVPA, ≥3 MET) was 7.92 MET-hours/day. A 1-way ANCOVA showed that total physical activity differed depending on the type of residential area (F2,2027=5.19, P=.006). The urban areas (n=950) had the lowest MET-hours/day (mean 37.8, SD, 6.0), followed by urban-rural areas (n=432; mean 38.6, SD 6.5; P=.04), and rural areas (n=664; mean 38.8, SD 7.4; P=.002). Two-way ANCOVA showed a significant interaction between sex and area of residence on the urban scale (F2,2036=4.53, P=.01). Men in urban areas had the lowest MET-hours/day (MVPA, ≥3 MET) at mean 7.9 (SD 8.7); men in rural areas had a MET-hours/day (MVPA, ≥3 MET) of mean 10.8 (SD 12.1, P=.002). No significant difference was noted in women among the 3 residential areas. Multiple regression analysis showed that physical activity consisting of standing while working was the highest contributor to MVPA, regardless of sex. Conclusions We were able to compile a detailed comparison of physical activity because our Web-based physical activity record system allowed for the simultaneous evaluation of physical activity from 2046 Japanese people. We found that rural residents had greater total physical activity than urban residents and that working and transportation behaviors differed depending on region type. Multiple regression analysis showed that the behaviors affected MVPA. People are less physically active while working, and sports and active transportation might be effective ways of increasing physical activity levels.
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Affiliation(s)
- Hideyuki Namba
- Department of Health and Nutrition, Wayo Women's University, Ichikawa, Chiba, Japan.
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Abel ML, Lee K, Loglisci R, Righter A, Hipper TJ, Cheskin LJ. Consumer Understanding of Calorie Labeling. Health Promot Pract 2014; 16:236-43. [DOI: 10.1177/1524839914543105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objective. To assess caloric knowledge of participants and determine if an e-mail and/or text message intervention could increase knowledge of recommended daily caloric intake. Design. Randomized, control trial. Setting. Johns Hopkins Hospital Cobblestone Café. Participants. The 246 participants reported eating at the Café at least twice/week. Intervention(s). Participants randomized to control, e-mail, or text condition. The text and e-mail conditions received a message on four consecutive Mondays stating the recommended daily caloric intake. Main outcome measures. Knowledge of the government reference value of 2,000 calories. Analysis. Intention-to-treat analysis was conducted. Multivariate logistic regression examined the effectiveness of text and e-mail messaging for improving knowledge of the government calorie reference value. Results. Baseline awareness of the daily calorie reference value in study population was low. Participants in the text message condition were twice as likely to know the government calorie reference value compared to controls ( p = .047, odds ratio = 2.2, 95% confidence interval [1.01, 4.73]). No significant differences were found for the e-mail condition ( p = .5). Conclusions and implications. Many people do not know the daily recommended caloric intake. Public education on the government calorie reference value is necessary for menu-labeling interventions to be more effective. Weekly text messaging can serve as an effective modality for delivering calorie information and nutrition education.
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Affiliation(s)
- Michelle L. Abel
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Katherine Lee
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ralph Loglisci
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Allison Righter
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Thomas J. Hipper
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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O'Reilly GA, Spruijt-Metz D. Current mHealth technologies for physical activity assessment and promotion. Am J Prev Med 2013; 45:501-7. [PMID: 24050427 PMCID: PMC4199827 DOI: 10.1016/j.amepre.2013.05.012] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 04/16/2013] [Accepted: 05/22/2013] [Indexed: 11/20/2022]
Abstract
CONTEXT Novel mobile assessment and intervention capabilities are changing the face of physical activity (PA) research. A comprehensive systematic review of how mobile technology has been used for measuring PA and promoting PA behavior change is needed. EVIDENCE ACQUISITION Article collection was conducted using six databases from February to June 2012 with search terms related to mobile technology and PA. Articles that described the use of mobile technologies for PA assessment, sedentary behavior assessment, and/or interventions for PA behavior change were included. Articles were screened for inclusion and study information was extracted. EVIDENCE SYNTHESIS Analyses were conducted from June to September 2012. Mobile phone-based journals and questionnaires, short message service (SMS) prompts, and on-body PA sensing systems were the mobile technologies most utilized. Results indicate that mobile journals and questionnaires are effective PA self-report measurement tools. Intervention studies that reported successful promotion of PA behavior change employed SMS communication, mobile journaling, or both SMS and mobile journaling. CONCLUSIONS mHealth technologies are increasingly being employed to assess and intervene on PA in clinical, epidemiologic, and intervention research. The wide variations in technologies used and outcomes measured limit comparability across studies, and hamper identification of the most promising technologies. Further, the pace of technologic advancement currently outstrips that of scientific inquiry. New adaptive, sequential research designs that take advantage of ongoing technology development are needed. At the same time, scientific norms must shift to accept "smart," adaptive, iterative, evidence-based assessment and intervention technologies that will, by nature, improve during implementation.
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Affiliation(s)
- Gillian A O'Reilly
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.
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Löf M, Henriksson H, Forsum E. Evaluations of Actiheart, IDEEA® and RT3 monitors for estimating activity energy expenditure in free-living women. J Nutr Sci 2013; 2:e31. [PMID: 25191581 PMCID: PMC4153312 DOI: 10.1017/jns.2013.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 04/25/2013] [Accepted: 06/07/2013] [Indexed: 11/07/2022] Open
Abstract
Activity energy expenditure (AEE) during free-living conditions can be assessed using devices based on different principles. To make proper comparisons of different devices' capacities to assess AEE, they should be evaluated in the same population. Thus, in the present study we evaluated, in the same group of subjects, the ability of three devices to assess AEE in groups and individuals during free-living conditions. In twenty women, AEE was assessed using RT3 (three-axial accelerometry) (AEERT3), Actiheart (a combination of heart rate and accelerometry) (AEEActi) and IDEEA (a multi-accelerometer system) (AEEIDEEA). Reference AEE (AEEref) was assessed using the doubly labelled water method and indirect calorimetry. Average AEEActi was 5760 kJ per 24 h and not significantly different from AEEref (5020 kJ per 24 h). On average, AEERT3 and AEEIDEEA were 2010 and 1750 kJ per 24 h lower than AEEref, respectively (P < 0·001). The limits of agreement (± 2 sd) were 2940 (Actiheart), 1820 (RT3) and 2650 (IDEEA) kJ per 24 h. The variance for AEERT3 was lower than for AEEActi (P = 0·006). The RT3 classified 60 % of the women in the correct activity category while the corresponding value for IDEEA and Actiheart was 30 %. In conclusion, the Actiheart may be useful for groups and the RT3 for individuals while the IDEEA requires further development. The results are likely to be relevant for a large proportion of Western women of reproductive age and demonstrate that the procedure selected to assess physical activity can greatly influence the possibilities to uncover important aspects regarding interactions between physical activity, diet and health.
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Key Words
- AEE, activity energy expenditure
- AEE5dresult, total energy expenditure, measured using the doubly labelled water method during days 1–5 minus BMR measured using indirect calorimetry
- AEEActi, activity energy expenditure assessed using Actiheart
- AEEIDEEA, activity energy expenditure assessed using IDEEA
- AEERT3, activity energy expenditure assessed using RT3
- AEEref, activity energy expenditure assessed using the doubly labelled water method and indirect calorimetry
- Accuracy
- Activity energy expenditure
- Activity monitors
- CountsActi, counts using Actiheart
- CountsIDEEA, counts using IDEEA
- CountsRT3, counts using RT3
- DIT, dietary induced thermogenesis
- Doubly labelled water
- HRaR, heart rate above resting heart rate
- MET, metabolic equivalent
- TEE, total energy expenditure
- TEE5dresult, TEE during days 1–5
- TEEIDEEA, total energy expenditure measured using IDEEA
- TEEref, total energy expenditure measured using the doubly labelled water method
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Affiliation(s)
- Marie Löf
- Department of Clinical and Experimental Medicine,
Faculty of Health Science, Linköping University,
Linköping, Sweden
- Department of Biosciences and Nutrition,
Karolinska Institutet, Stockholm,
Sweden
| | - Hanna Henriksson
- Department of Clinical and Experimental Medicine,
Faculty of Health Science, Linköping University,
Linköping, Sweden
- Department of Biosciences and Nutrition,
Karolinska Institutet, Stockholm,
Sweden
| | - Elisabet Forsum
- Department of Clinical and Experimental Medicine,
Faculty of Health Science, Linköping University,
Linköping, Sweden
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Kumar S, Nilsen WJ, Abernethy A, Atienza A, Patrick K, Pavel M, Riley WT, Shar A, Spring B, Spruijt-Metz D, Hedeker D, Honavar V, Kravitz R, Lefebvre RC, Mohr DC, Murphy SA, Quinn C, Shusterman V, Swendeman D. Mobile health technology evaluation: the mHealth evidence workshop. Am J Prev Med 2013; 45:228-36. [PMID: 23867031 PMCID: PMC3803146 DOI: 10.1016/j.amepre.2013.03.017] [Citation(s) in RCA: 499] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 01/16/2013] [Accepted: 03/22/2013] [Indexed: 11/24/2022]
Abstract
Creative use of new mobile and wearable health information and sensing technologies (mHealth) has the potential to reduce the cost of health care and improve well-being in numerous ways. These applications are being developed in a variety of domains, but rigorous research is needed to examine the potential, as well as the challenges, of utilizing mobile technologies to improve health outcomes. Currently, evidence is sparse for the efficacy of mHealth. Although these technologies may be appealing and seemingly innocuous, research is needed to assess when, where, and for whom mHealth devices, apps, and systems are efficacious. In order to outline an approach to evidence generation in the field of mHealth that would ensure research is conducted on a rigorous empirical and theoretic foundation, on August 16, 2011, researchers gathered for the mHealth Evidence Workshop at NIH. The current paper presents the results of the workshop. Although the discussions at the meeting were cross-cutting, the areas covered can be categorized broadly into three areas: (1) evaluating assessments; (2) evaluating interventions; and (3) reshaping evidence generation using mHealth. This paper brings these concepts together to describe current evaluation standards, discuss future possibilities, and set a grand goal for the emerging field of mHealth research.
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Affiliation(s)
- Santosh Kumar
- Department of Computer Science, University of Memphis, Memphis, TN, USA
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Buchholz SW, Wilbur J, Ingram D, Fogg L. Physical Activity Text Messaging Interventions in Adults: A Systematic Review. Worldviews Evid Based Nurs 2013; 10:163-73. [DOI: 10.1111/wvn.12002] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2010] [Indexed: 01/31/2023]
Affiliation(s)
| | - JoEllen Wilbur
- Professor and Associate Dean for Research; Endowed Independence Foundation Chair in Nursing; Rush University College of Nursing; Chicago; IL
| | - Diana Ingram
- Project Director, Women's Walking Program; Rush University College of Nursing; Chicago; IL
| | - Louis Fogg
- Associate Professor; Rush University College of Nursing; Chicago; IL
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Hedlund L, Brembeck P, Olausson H. Determinants of vitamin D status in fair-skinned women of childbearing age at northern latitudes. PLoS One 2013; 8:e60864. [PMID: 23593333 PMCID: PMC3621883 DOI: 10.1371/journal.pone.0060864] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 03/04/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Poor vitamin D status during pregnancy has been associated with unfavorable outcomes for mother and child. Thus, adequate vitamin D status in women of childbearing age may be important. The aim of this study is to investigate the determinants of 25-hydroxyvitamin D (25(OH)D) serum concentrations in women of childbearing age living in Sweden, at latitude 57-58° north. METHOD Eighty four non-pregnant, non-lactating, healthy, fair-skinned women aged between 25-40 years were included. All subjects provided blood samples, four day food records and answered questionnaires about sun exposure and lifestyle. Total serum 25(OH)D was analyzed using Roche Cobas® electrochemoluminiescent immunoassay. RESULTS Mean 25(OH)D was 65.8±19.9 nmol/l and 23% of the subjects had concentrations <50 nmol/l. Only 1% had concentrations <25 nmol/l. Determinants of 25(OH)D concentrations were recent sunbed use, recent travel to southern latitude, season, estrogen contraceptive use and use of supplementary vitamin D (R(2) = 0.27). CONCLUSION Every fifth woman had 25(OH)D concentrations <50 nmol/l. About 30% of the variation in vitamin D status was explained by sun exposure, use of vitamin D supplements and use of estrogen contraceptives. Cutaneous vitamin D synthesis seems to be a major contributor to vitamin D status, even at northern latitudes. Thus, recommendations on safe UV-B exposure could be beneficial for vitamin D status.
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Affiliation(s)
- Linnea Hedlund
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Pfaeffli L, Maddison R, Jiang Y, Dalleck L, Löf M. Measuring physical activity in a cardiac rehabilitation population using a smartphone-based questionnaire. J Med Internet Res 2013; 15:e61. [PMID: 23524251 PMCID: PMC3636157 DOI: 10.2196/jmir.2419] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 12/19/2012] [Accepted: 01/22/2013] [Indexed: 11/13/2022] Open
Abstract
Background Questionnaires are commonly used to assess physical activity in large population-based studies because of their low cost and convenience. Many self-report physical activity questionnaires have been shown to be valid and reliable measures, but they are subject to measurement errors and misreporting, often due to lengthy recall periods. Mobile phones offer a novel approach to measure self-reported physical activity on a daily basis and offer real-time data collection with the potential to enhance recall. Objective The aims of this study were to determine the convergent validity of a mobile phone physical activity (MobilePAL) questionnaire against accelerometry in people with cardiovascular disease (CVD), and to compare how the MobilePAL questionnaire performed compared with the commonly used self-recall International Physical Activity Questionnaire (IPAQ). Methods Thirty adults aged 49 to 85 years with CVD were recruited from a local exercise-based cardiac rehabilitation clinic in Auckland, New Zealand. All participants completed a demographics questionnaire and underwent a 6-minute walk test at the first visit. Subsequently, participants were temporarily provided a smartphone (with the MobilePAL questionnaire preloaded that asked 2 questions daily) and an accelerometer, which was to be worn for 7 days. After 1 week, a follow-up visit was completed during which the smartphone and accelerometer were returned, and participants completed the IPAQ. Results Average daily physical activity level measured using the MobilePAL questionnaire showed moderate correlation (r=.45; P=.01) with daily activity counts per minute (Acc_CPM) and estimated metabolic equivalents (MET) (r=.45; P=.01) measured using the accelerometer. Both MobilePAL (beta=.42; P=.008) and age (beta=–.48, P=.002) were significantly associated with Acc_CPM (adjusted R2=.40). When IPAQ-derived energy expenditure, measured in MET-minutes per week (IPAQ_met), was considered in the predicted model, both IPAQ_met (beta=.51; P=.001) and age (beta=–.36; P=.016) made unique contributions (adjusted R2=.47, F2,27=13.58; P<.001).There was also a significant association between the MobilePAL and IPAQ measures (r=.49, beta=.51; P=.007). Conclusions A mobile phone–delivered questionnaire is a relatively reliable and valid measure of physical activity in a CVD cohort. Reliability and validity measures in the present study are comparable to existing self-report measures. Given their ubiquitous use, mobile phones may be an effective method for physical activity surveillance data collection.
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Affiliation(s)
- Leila Pfaeffli
- The National Institute for Health Innovation, University of Auckland, Auckland, New Zealand.
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Abstract
Low maternal vitamin D status during pregnancy may have negative consequences for both mother and child. There are few studies of vitamin D status and its determinants in pregnant women living at northern latitudes. Thus, the present study investigates vitamin D status and its determinants during the third trimester of women living in Sweden (latitudes 57-58°N). A total of ninety-five fair-skinned pregnant women had blood taken between gestational weeks 35 and 37. The study included a 4 d food diary and questionnaires on dietary intake, supplement use, sun exposure, skin type, travels to southern latitudes and measure of BMI. Serum 25-hydroxyvitamin D (25(OH)D) was analysed using the chemiluminescence immunoassay. In the third trimester of pregnancy, mean serum concentration of 25(OH)D was 47.4 (sd 18.1) nmol/l (range 10-93 nmol/l). In total, 65% of women had serum 25(OH)D < 50 nmol/l and 17 % < 30 nmol/l. During the winter, 85% of the pregnant women had serum 25(OH)D < 50 nmol/l and 28 % < 30 nmol/l. The main determinants of vitamin D status were as follows: season; use of vitamin D supplements; travels to southern latitudes. Together, these explained 51% of the variation in 25(OH)D. In conclusion, during the winter, the majority of fair-skinned pregnant women had serum 25(OH)D < 50 nmol/l in their third trimester and more than every fourth woman < 30 nmol/l. Higher vitamin D intake may therefore be needed during the winter for fair-skinned pregnant women at northern latitudes to avoid vitamin D deficiency.
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Rotheram-Borus MJ, Tomlinson M, Swendeman D, Lee A, Jones E. Standardized functions for smartphone applications: examples from maternal and child health. Int J Telemed Appl 2012; 2012:973237. [PMID: 23304136 PMCID: PMC3530862 DOI: 10.1155/2012/973237] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Accepted: 09/18/2012] [Indexed: 01/30/2023] Open
Abstract
Millennium Development Goals (MDGs) are unlikely to be met in most low- and middle-income countries (LMIC). Smartphones and smartphone proxy systems using simpler phones, equipped with the capabilities to identify location/time and link to the web, are increasingly available and likely to provide an excellent platform to support healthcare self-management, delivery, quality, and supervision. Smart phones allow information to be delivered by voice, texts, pictures, and videos as well as be triggered by location and date. Prompts and reminders, as well as real-time monitoring, can improve quality of health care. We propose a three-tier model for designing platforms for both professional and paraprofessional health providers and families: (1) foundational functions (informing, training, monitoring, shaping, supporting, and linking to care); (2) content-specific targets (e.g., for MDG; developmentally related tasks); (3) local cultural adaptations (e.g., language). We utilize the Maternal and Child Health (MCH) MDG in order to demonstrate how the existing literature can be organized and leveraged on open-source platforms and provide examples using our own experience in Africa over the last 8 years.
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Affiliation(s)
- Mary Jane Rotheram-Borus
- Semel Institute for Neuroscience and Human Behaviour, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA 90024, USA
| | - Mark Tomlinson
- Department of Psychology, Wilcocks Building, Ryneveld Street, Stellenbosch 7600, South Africa
| | - Dallas Swendeman
- Semel Institute for Neuroscience and Human Behaviour, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA 90024, USA
| | - Adabel Lee
- Semel Institute for Neuroscience and Human Behaviour, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA 90024, USA
| | - Erynne Jones
- Semel Institute for Neuroscience and Human Behaviour, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA 90024, USA
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Abstract
Historically, the approach of promoting exercise by emphasizing its effects on long-term health has predominated. Despite this tradition, there is no strong empirical support for such an approach. Recent work has argued that exercise suffers from a “branding problem” and efforts to promote exercise may be better served by switching the focus from the long-term benefits of exercise that improve health, to the immediate benefits of exercise that enhance quality of life. One way to disseminate and reinforce this message could be through a smartphone application designed to monitor daily improvements on quality of life constructs correlated with exercise participation.
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Namba H, Yamaguchi Y, Yamada Y, Tokushima S, Hatamoto Y, Sagayama H, Kimura M, Higaki Y, Tanaka H. Validation of Web-based physical activity measurement systems using doubly labeled water. J Med Internet Res 2012; 14:e123. [PMID: 23010345 PMCID: PMC3517333 DOI: 10.2196/jmir.2253] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 08/17/2012] [Accepted: 08/25/2012] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Online or Web-based measurement systems have been proposed as convenient methods for collecting physical activity data. We developed two Web-based physical activity systems-the 24-hour Physical Activity Record Web (24hPAR WEB) and 7 days Recall Web (7daysRecall WEB). OBJECTIVE To examine the validity of two Web-based physical activity measurement systems using the doubly labeled water (DLW) method. METHODS We assessed the validity of the 24hPAR WEB and 7daysRecall WEB in 20 individuals, aged 25 to 61 years. The order of email distribution and subsequent completion of the two Web-based measurements systems was randomized. Each measurement tool was used for a week. The participants' activity energy expenditure (AEE) and total energy expenditure (TEE) were assessed over each week using the DLW method and compared with the respective energy expenditures estimated using the Web-based systems. RESULTS The mean AEE was 3.90 (SD 1.43) MJ estimated using the 24hPAR WEB and 3.67 (SD 1.48) MJ measured by the DLW method. The Pearson correlation for AEE between the two methods was r = .679 (P < .001). The Bland-Altman 95% limits of agreement ranged from -2.10 to 2.57 MJ between the two methods. The Pearson correlation for TEE between the two methods was r = .874 (P < .001). The mean AEE was 4.29 (SD 1.94) MJ using the 7daysRecall WEB and 3.80 (SD 1.36) MJ by the DLW method. The Pearson correlation for AEE between the two methods was r = .144 (P = .54). The Bland-Altman 95% limits of agreement ranged from -3.83 to 4.81 MJ between the two methods. The Pearson correlation for TEE between the two methods was r = .590 (P = .006). The average input times using terminal devices were 8 minutes and 10 seconds for the 24hPAR WEB and 6 minutes and 38 seconds for the 7daysRecall WEB. CONCLUSIONS Both Web-based systems were found to be effective methods for collecting physical activity data and are appropriate for use in epidemiological studies. Because the measurement accuracy of the 24hPAR WEB was moderate to high, it could be suitable for evaluating the effect of interventions on individuals as well as for examining physical activity behavior.
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Affiliation(s)
- Hideyuki Namba
- Faculty of Sports and Health Science, Fukuoka University, Fukuoka, Japan.
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Mosa ASM, Yoo I, Sheets L. A systematic review of healthcare applications for smartphones. BMC Med Inform Decis Mak 2012; 12:67. [PMID: 22781312 PMCID: PMC3534499 DOI: 10.1186/1472-6947-12-67] [Citation(s) in RCA: 542] [Impact Index Per Article: 45.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 06/14/2012] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Advanced mobile communications and portable computation are now combined in handheld devices called "smartphones", which are also capable of running third-party software. The number of smartphone users is growing rapidly, including among healthcare professionals. The purpose of this study was to classify smartphone-based healthcare technologies as discussed in academic literature according to their functionalities, and summarize articles in each category. METHODS In April 2011, MEDLINE was searched to identify articles that discussed the design, development, evaluation, or use of smartphone-based software for healthcare professionals, medical or nursing students, or patients. A total of 55 articles discussing 83 applications were selected for this study from 2,894 articles initially obtained from the MEDLINE searches. RESULTS A total of 83 applications were documented: 57 applications for healthcare professionals focusing on disease diagnosis (21), drug reference (6), medical calculators (8), literature search (6), clinical communication (3), Hospital Information System (HIS) client applications (4), medical training (2) and general healthcare applications (7); 11 applications for medical or nursing students focusing on medical education; and 15 applications for patients focusing on disease management with chronic illness (6), ENT-related (4), fall-related (3), and two other conditions (2). The disease diagnosis, drug reference, and medical calculator applications were reported as most useful by healthcare professionals and medical or nursing students. CONCLUSIONS Many medical applications for smartphones have been developed and widely used by health professionals and patients. The use of smartphones is getting more attention in healthcare day by day. Medical applications make smartphones useful tools in the practice of evidence-based medicine at the point of care, in addition to their use in mobile clinical communication. Also, smartphones can play a very important role in patient education, disease self-management, and remote monitoring of patients.
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Affiliation(s)
- Abu Saleh Mohammad Mosa
- University of Missouri Informatics Institute (MUII), 241 Engineering Building West, Columbia, MO, 65211, USA
| | - Illhoi Yoo
- University of Missouri Informatics Institute (MUII), 241 Engineering Building West, Columbia, MO, 65211, USA
- Health Management and Informatics (HMI) Department, University of Missouri School of Medicine, CS&E Bldg. DC006.00, Columbia, MO, 65212, USA
| | - Lincoln Sheets
- University of Missouri Informatics Institute (MUII), 241 Engineering Building West, Columbia, MO, 65211, USA
- Department of Family and Community Medicine, University of Missouri School of Medicine, M226 Medical Sciences Building, DC032.00, Columbia, MO, 65212, USA
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Lagerros YT, Sandin S, Bexelius C, Litton JE, Löf M. Estimating physical activity using a cell phone questionnaire sent by means of short message service (SMS): a randomized population-based study. Eur J Epidemiol 2012; 27:561-6. [DOI: 10.1007/s10654-012-9708-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 06/12/2012] [Indexed: 01/09/2023]
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Daugherty BL, Schap TE, Ettienne-Gittens R, Zhu FM, Bosch M, Delp EJ, Ebert DS, Kerr DA, Boushey CJ. Novel technologies for assessing dietary intake: evaluating the usability of a mobile telephone food record among adults and adolescents. J Med Internet Res 2012; 14:e58. [PMID: 22504018 PMCID: PMC3376510 DOI: 10.2196/jmir.1967] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 02/10/2012] [Accepted: 03/09/2012] [Indexed: 02/01/2023] Open
Abstract
Background The development of a mobile telephone food record has the potential to ameliorate much of the burden associated with current methods of dietary assessment. When using the mobile telephone food record, respondents capture an image of their foods and beverages before and after eating. Methods of image analysis and volume estimation allow for automatic identification and volume estimation of foods. To obtain a suitable image, all foods and beverages and a fiducial marker must be included in the image. Objective To evaluate a defined set of skills among adolescents and adults when using the mobile telephone food record to capture images and to compare the perceptions and preferences between adults and adolescents regarding their use of the mobile telephone food record. Methods We recruited 135 volunteers (78 adolescents, 57 adults) to use the mobile telephone food record for one or two meals under controlled conditions. Volunteers received instruction for using the mobile telephone food record prior to their first meal, captured images of foods and beverages before and after eating, and participated in a feedback session. We used chi-square for comparisons of the set of skills, preferences, and perceptions between the adults and adolescents, and McNemar test for comparisons within the adolescents and adults. Results Adults were more likely than adolescents to include all foods and beverages in the before and after images, but both age groups had difficulty including the entire fiducial marker. Compared with adolescents, significantly more adults had to capture more than one image before (38% vs 58%, P = .03) and after (25% vs 50%, P = .008) meal session 1 to obtain a suitable image. Despite being less efficient when using the mobile telephone food record, adults were more likely than adolescents to perceive remembering to capture images as easy (P < .001). Conclusions A majority of both age groups were able to follow the defined set of skills; however, adults were less efficient when using the mobile telephone food record. Additional interactive training will likely be necessary for all users to provide extra practice in capturing images before entering a free-living situation. These results will inform age-specific development of the mobile telephone food record that may translate to a more accurate method of dietary assessment.
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Affiliation(s)
- Bethany L Daugherty
- Department of Nutrition, Purdue University, West Lafayatte, IN, United States
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Bexelius C, Sandin S, Trolle Lagerros Y, Litton JE, Löf M. Estimation of physical activity levels using cell phone questionnaires: a comparison with accelerometry for evaluation of between-subject and within-subject variations. J Med Internet Res 2011; 13:e70. [PMID: 21946080 PMCID: PMC3222159 DOI: 10.2196/jmir.1686] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 05/19/2011] [Accepted: 05/19/2011] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Physical activity promotes health and longevity. Further elaboration of the role of physical activity for human health in epidemiological studies on large samples requires accurate methods that are easy to use, cheap, and possible to repeat. The use of telecommunication technologies such as cell phones is highly interesting in this respect. In an earlier report, we showed that physical activity level (PAL) assessed using a cell phone procedure agreed well with corresponding estimates obtained using the doubly labeled water method. However, our earlier study indicated high within-subject variation in relation to between-subject variations in PAL using cell phones, but we could not assess if this was a true variation of PAL or an artifact of the cell phone technique. OBJECTIVE Our objective was to compare within- and between-subject variations in PAL by means of cell phones with corresponding estimates using an accelerometer. In addition, we compared the agreement of daily PAL values obtained using the cell phone questionnaire with corresponding data obtained using an accelerometer. METHODS PAL was measured both with the cell phone questionnaire and with a triaxial accelerometer daily during a 2-week study period in 21 healthy Swedish women (20 to 45 years of age and BMI from 17.7 kg/m² to 33.6 kg/m²). The results were evaluated by fitting linear mixed effect models and descriptive statistics and graphs. RESULTS With the accelerometer, 57% (95% confidence interval [CI] 40%-66%) of the variation was within subjects, while with the cell phone, within-subject variation was 76% (95% CI 59%-83%). The day-to-day variations in PAL observed using the cell phone questions agreed well with the corresponding accelerometer results. CONCLUSIONS Both the cell phone questionnaire and the accelerometer showed high within-subject variations. Furthermore, day-to-day variations in PAL within subjects assessed using the cell phone agreed well with corresponding accelerometer values. Consequently, our cell phone questionnaire is a promising tool for assessing levels of physical activity. The tool may be useful for large-scale prospective studies.
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Affiliation(s)
- Christin Bexelius
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Löf M. Physical activity pattern and activity energy expenditure in healthy pregnant and non-pregnant Swedish women. Eur J Clin Nutr 2011; 65:1295-301. [PMID: 21792212 DOI: 10.1038/ejcn.2011.129] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Energy costs of pregnancy approximate 320 MJ in well-nourished women, but whether or not these costs may be partly covered by modifications in activity behavior is incompletely known. In healthy Swedish women: (1) to evaluate the potential of the Intelligent Device for Energy Expenditure and Physical Activity (IDEEA) to assess energy expenditure during free-living conditions, (2) to assess activity pattern, walking pace and energy metabolism in pregnant women and non-pregnant controls, and (3) to assess the effect on energy expenditure caused by changes in physical activity induced by pregnancy. SUBJECTS/METHODS Activity pattern was assessed using the IDEEA in 18 women in gestational week 32 and in 21 non-pregnant women. Activity energy expenditure (AEE) was assessed using IDEEA, as well as using the doubly labelled water method and indirect calorimetry. RESULTS AEE using the IDEEA was correlated with reference estimates in both groups (r=0.4-0.5; P<0.05). Reference AEE was 0.9 MJ/24 h lower in pregnant than in non-pregnant women. Pregnant women spent 92 min/24 h more on sitting, lying, reclining and sleeping (P=0.020), 73 min/24 h less on standing (P=0.037) and 21 min/24 h less on walking and using stairs (P=0.049), and walked at a slower pace (1.1 ± 0.1 m/s versus 1.2±0.1 m/s; P=0.014) than did non-pregnant controls. The selection of less demanding activities and slower walking pace decreased energy costs by 720 kJ/24 h and 80 kJ/24 h, respectively. CONCLUSION Healthy moderately active Swedish women compensated for the increased energy costs of pregnancy by 0.9 MJ/24 h. The compensation was mainly achieved by selecting less demanding activities.
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Affiliation(s)
- M Löf
- Division of nutrition, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
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Dunton GF, Liao Y, Intille SS, Spruijt-Metz D, Pentz M. Investigating children's physical activity and sedentary behavior using ecological momentary assessment with mobile phones. Obesity (Silver Spring) 2011; 19:1205-12. [PMID: 21164502 DOI: 10.1038/oby.2010.302] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The risk of obesity during childhood can be significantly reduced through increased physical activity and decreased sedentary behavior. Recent technological advances have created opportunities for the real-time measurement of these behaviors. Mobile phones are ubiquitous and easy to use, and thus have the capacity to collect data from large numbers of people. The present study tested the feasibility, acceptability, and validity of an electronic ecological momentary assessment (EMA) protocol using electronic surveys administered on the display screen of mobile phones to assess children's physical activity and sedentary behaviors. A total of 121 children (ages 9-13, 51% male, 38% at risk for overweight/overweight) participated in EMA monitoring from Friday afternoon to Monday evening during children's nonschool time, with 3-7 surveys/day. Items assessed current activity (e.g., watching TV/movies, playing video games, active play/sports/exercising). Children simultaneously wore an Actigraph GT2M accelerometer. EMA survey responses were time-matched to total step counts and minutes of moderate-to-vigorous physical activity (MVPA) occurring in the 30 min before each EMA survey prompt. No significant differences between answered and unanswered EMA surveys were found for total steps or MVPA. Step counts and the likelihood of 5+ min of MVPA were significantly higher during EMA-reported physical activity (active play/sports/exercising) vs. sedentary behaviors (reading/computer/homework, watching TV/movies, playing video games, riding in a car) (P < 0.001). Findings generally support the acceptability and validity of a 4-day EMA protocol using mobile phones to measure physical activity and sedentary behavior in children during leisure time.
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Affiliation(s)
- Genevieve F Dunton
- Department of Preventive Medicine, University of Southern California, Alhambra, California, USA.
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Riley WT, Rivera DE, Atienza AA, Nilsen W, Allison SM, Mermelstein R. Health behavior models in the age of mobile interventions: are our theories up to the task? Transl Behav Med 2011; 1:53-71. [PMID: 21796270 PMCID: PMC3142960 DOI: 10.1007/s13142-011-0021-7] [Citation(s) in RCA: 603] [Impact Index Per Article: 46.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Mobile technologies are being used to deliver health behavior interventions. The study aims to determine how health behavior theories are applied to mobile interventions. This is a review of the theoretical basis and interactivity of mobile health behavior interventions. Many of the mobile health behavior interventions reviewed were predominately one way (i.e., mostly data input or informational output), but some have leveraged mobile technologies to provide just-in-time, interactive, and adaptive interventions. Most smoking and weight loss studies reported a theoretical basis for the mobile intervention, but most of the adherence and disease management studies did not. Mobile health behavior intervention development could benefit from greater application of health behavior theories. Current theories, however, appear inadequate to inform mobile intervention development as these interventions become more interactive and adaptive. Dynamic feedback system theories of health behavior can be developed utilizing longitudinal data from mobile devices and control systems engineering models.
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Affiliation(s)
- William T Riley
- National Heart, Lung, and Blood Institute, NIH, 6701 Rockledge Dr, Room 10224, MSC 7936, Bethesda, MD 20892-7936 USA
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Pearson JF, Brownstein CA, Brownstein JS. Potential for electronic health records and online social networking to redefine medical research. Clin Chem 2010; 57:196-204. [PMID: 21159898 DOI: 10.1373/clinchem.2010.148668] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Recent legislation in the US requires that all medical records become electronic over the next decade. In addition, ongoing developments in patient-oriented care, most notably with the advent of health social networking and personal health records, provide a plethora of new information sources for research. CONTENT Electronic health records (EHRs) show great potential for use in observational studies to examine drug safety via pharmacovigiliance methods that can find adverse drug events as well as expand drug safety profiles. EHRs also show promise for head-to-head comparative effectiveness trials and could play a critical role in secondary and tertiary diabetes prevention efforts. A growing subset of EHRs, personal health records (PHRs), opens up the possibility of engaging patients in their care, as well as new opportunities for participatory research and personalized medicine. Organizations nationwide, from providers to employers, are already investing heavily in PHR systems. Additionally, the explosive use of online social networking sites and mobile technologies will undoubtedly play a role in future research efforts by making available a veritable flood of information, such as real-time exercise monitoring, to health researchers. SUMMARY The future confluence of health information technologies will enable researchers and clinicians to reveal novel therapies and insights into treatments and disease management, as well as environmental and genomic interactions, at an unprecedented population scale.
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Affiliation(s)
- John F Pearson
- Children's Hospital Informatics Program at the Harvard-MIT Division of Health Sciences and Technology, Boston, MA, USA
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Bellocco R, Jia C, Ye W, Lagerros YT. Effects of physical activity, body mass index, waist-to-hip ratio and waist circumference on total mortality risk in the Swedish National March Cohort. Eur J Epidemiol 2010; 25:777-88. [PMID: 20730597 DOI: 10.1007/s10654-010-9497-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Accepted: 07/26/2010] [Indexed: 11/24/2022]
Abstract
The health benefits of physical activity (PA) have been well documented. However, there is less research investigating whether or not these health benefits might differ among males and females or among subjects characterized by different levels of body mass index (BMI), waist-to-hip ratio (WHR), and waist circumference (WC). Baseline total PA, BMI, WHR and waist circumference were measured in 14,585 men and 26,144 women who participated in the Swedish National March. Their effects on all-cause mortality were analyzed with a follow-up time of almost 10 years. Sedentary men with a BMI ≥ 30 had a 98% (95% CI: 30-201%) increased risk of mortality compared to normal weight men with a high level of total PA. The same trend was observed for sedentary men with high WHR or waist circumference, compared to lean and highly active men. Sedentary women with a waist circumference of 88 cm or more had almost doubled, i.e. 97% (95% CI: 35-189%) increased mortality risk compared to physically active women with a waist circumference below 80 cm. BMI in men, but waist circumference in women better forecast all-cause mortality. We found no substantial effect modification between different measures of adiposity and physical activity-physical inactivity and obesity seem to increase total mortality risk independently and additively.
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Affiliation(s)
- Rino Bellocco
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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