Imperial College London

DrLorainneTudor Car

Faculty of MedicineSchool of Public Health

Honorary Senior Research Fellow
 
 
 
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Contact

 

l.tudor.car

 
 
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Location

 

Reynolds BuildingCharing Cross Campus

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Summary

 

Publications

Publication Type
Year
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165 results found

Soon CSL, Tudor Car L, Ng CJ, Tan NC, Smith Het al., 2022, What Is the Utility of Posters? Qualitative Study of Participants at a Regional Primary Healthcare Conference in Asia., Med Sci Educ, Pages: 1-8

Background: Posters are used extensively as a mode of presentation at scientific conferences, but little is documented about their value to presenters or viewers. The study aimed to explore conference delegates' views and experiences of poster presentations, and their perceptions of the strengths and weaknesses of posters compared with oral presentations, and also to identify ways to enhance the educational value of posters. Method: This was a qualitative study using brief, semi-structured, face-to-face interviews amongst delegates at a 3-day Asia Pacific regional academic primary care conference in Singapore. Interviews were digitally recorded, transcribed verbatim, and their contents analysed thematically. Results: Eighty-nine interviews were analysed. Respondents were mainly early career researchers (58%), and a third were presenting (poster or oral) at the conference. Many positive attributes of posters were identified. For the viewers, these included the ability to gain a rapid overview of research activity (for "benchmarking", "updating", and "inspiration"); the ability to choose who to engage with and when, in contrast to the tightly scheduled oral sessions; and opportunity to discuss content in a leisurely and detailed fashion with the presenter. Presenters considered posters "less threatening" than oral presentations and valued posters for the networking opportunities they created. However, posters were reported to be more demanding on the skills of précis and their preparation was considered arduous and more expensive than an oral presentation. Posters were also perceived to have lower academic status and dominate the presenter's time at the conference, reducing the opportunities for them to see the work of others. Suggestions for incorporating technologies to enhance the impact of posters included QR codes to access more detailed information, pre-recorded presentations, and online interactive clarification se

Journal article

Chan FHF, Goh ZZS, Zhu X, Car LT, Newman S, Khan BA, Griva Ket al., 2022, Subjective cognitive complaints in end-stage renal disease: a systematic review and meta-analysis, HEALTH PSYCHOLOGY REVIEW, ISSN: 1743-7199

Journal article

Dhinagaran DA, Martinengo L, Ho M-HR, Joty S, Kowatsch T, Atun R, Tudor Car Let al., 2022, Designing, Developing, Evaluating, and Implementing a Smartphone-Delivered, Rule-Based Conversational Agent (DISCOVER): Development of a Conceptual Framework., JMIR Mhealth Uhealth, Vol: 10

BACKGROUND: Conversational agents (CAs), also known as chatbots, are computer programs that simulate human conversations by using predetermined rule-based responses or artificial intelligence algorithms. They are increasingly used in health care, particularly via smartphones. There is, at present, no conceptual framework guiding the development of smartphone-based, rule-based CAs in health care. To fill this gap, we propose structured and tailored guidance for their design, development, evaluation, and implementation. OBJECTIVE: The aim of this study was to develop a conceptual framework for the design, evaluation, and implementation of smartphone-delivered, rule-based, goal-oriented, and text-based CAs for health care. METHODS: We followed the approach by Jabareen, which was based on the grounded theory method, to develop this conceptual framework. We performed 2 literature reviews focusing on health care CAs and conceptual frameworks for the development of mobile health interventions. We identified, named, categorized, integrated, and synthesized the information retrieved from the literature reviews to develop the conceptual framework. We then applied this framework by developing a CA and testing it in a feasibility study. RESULTS: The Designing, Developing, Evaluating, and Implementing a Smartphone-Delivered, Rule-Based Conversational Agent (DISCOVER) conceptual framework includes 8 iterative steps grouped into 3 stages, as follows: design, comprising defining the goal, creating an identity, assembling the team, and selecting the delivery interface; development, including developing the content and building the conversation flow; and the evaluation and implementation of the CA. They were complemented by 2 cross-cutting considerations-user-centered design and privacy and security-that were relevant at all stages. This conceptual framework was successfully applied in the development of a CA to support lifestyle changes and prevent type 2 diabetes. CONCLUSIONS: Draw

Journal article

Martinengo L, Jabir AI, Goh WWT, Lo NYW, Ho M-HR, Kowatsch T, Atun R, Michie S, Car LTet al., 2022, Conversational Agents in Health Care: Scoping Review of Their Behavior Change Techniques and Underpinning Theory, JOURNAL OF MEDICAL INTERNET RESEARCH, Vol: 24, ISSN: 1438-8871

Journal article

Dhinagaran DA, Car LT, 2022, Public perceptions of a healthy lifestyle change conversational agent in Singapore: A qualitative study, DIGITAL HEALTH, Vol: 8, ISSN: 2055-2076

Journal article

Subramaniam M, Lau JH, Asharani P, Abdin E, Roystonn K, Wang P, Devi F, Vaingankar JA, Car LT, Sum CF, Lee ES, van Dam RM, Chong SAet al., 2022, Sources of information on diabetes and its demographic correlates: a nationwide survey among Singapore residents, HEALTH PROMOTION INTERNATIONAL, Vol: 37, ISSN: 0957-4824

Journal article

Peng Ng MS, Jabir AI, De Rong Ng T, Ang Y-I, Chia JL, Hao Tan DN, Lee J, Junis Mahendran DC, Car LT, Khng Chia CLet al., 2022, Evaluating TESLA-G, a gamified, Telegram-delivered, quizzing platform for surgical education in medical students: a protocol for a pilot randomised controlled trial

<jats:title>Abstract</jats:title><jats:sec><jats:title>Introduction</jats:title><jats:p>Online multiple-choice question (MCQ) quizzes are popular in medical education due to their ease of access and ability for test-enhanced learning. However, a general lack of motivation among students often results in decreasing usage over time. We aim to address this limitation by developing Telegram Education for Surgical Learning and Application Gamified (TESLA-G), an online platform for surgical education that incorporates game elements into conventional MCQ quizzes.</jats:p></jats:sec><jats:sec><jats:title>Methods and analysis</jats:title><jats:p>This online, pilot randomised control trial will be conducted over two weeks. Fifty full-time undergraduate medical students will be recruited and randomised into an intervention group (TESLA-G) and an active control group (non-gamified quizzing platform) with a 1:1 allocation ratio, stratified by year of study.</jats:p><jats:p>We will evaluate TESLA-G in the area of endocrine surgery education. Our platform is designed based on Bloom’s taxonomy of learning domains: questions are created in blocks of 5 questions per endocrine surgery topic, with each question corresponding to one level on Bloom’s taxonomy. This structure promotes mastery while boosting student engagement and motivation. All questions are created by two board-certified general surgeons and one endocrinologist, and validated by the research team.</jats:p><jats:p>The feasibility and acceptability of the pilot study will be assessed by participant recruitment and retention rates, acceptability of the intervention, adherence and task completion rate, fidelity of the intervention delivery, and perception of the intervention. The effectiveness of the intervention (TESLA-G) compared to the control will be assessed by improvement in knowledge from pre- to post-intervent

Journal article

Soon MKS, Martinengo L, Lu J, Car LT, Chia CLKet al., 2022, The Use of Telegram in Surgical Education: Exploratory Study., JMIR Med Educ, Vol: 8, ISSN: 2369-3762

BACKGROUND: The COVID-19 pandemic has disrupted medical education, shifting learning online. Social media platforms, including messaging apps, are well integrated into medical education. However, Telegram's role in medical education remains relatively unexplored. OBJECTIVE: This study aims to explore the perceptions of medical students regarding the role of messaging apps in medical education and their experience of using Telegram for surgical education. METHODS: A Telegram channel "Telegram Education for Surgery Learning and Application (TESLA)" was created to supplement medical students' learning. We invited 13 medical students who joined the TESLA channel for at least a month to participate in individual semistructured interviews. Interviews were conducted via videoconferencing using an interview guide and were then transcribed and analyzed by 2 researchers using inductive thematic content analysis. RESULTS: Two themes were identified: (1) learning as a medical student and (2) the role of mobile learning (mLearning) in medical education. Students shared that pandemic-related safety measures, such as reduced clinic allocations and the inability to cross between wards, led to a decrease in clinical exposure. Mobile apps, which included proprietary study apps and messaging apps, were increasingly used by students to aid their learning. Students favored Telegram over other messaging apps and reported the development of TESLA as beneficial, particularly for revision and increasing knowledge. CONCLUSIONS: The use of apps for medical education increased during the COVID-19 pandemic. Medical students commonly used apps to consolidate their learning and revise examination topics. They found TESLA useful, relevant, and trustworthy.

Journal article

Chen S, Sam XH, Soong A, Car LT, Lian S, Smith HEet al., 2022, Recruitment of general practitioners in China: a scoping review of strategies and challenges, BMC PRIMARY CARE, Vol: 23

Journal article

Tudor Car L, Chan FHF, Lin X, Griva K, Subramaniam M, Ćelić Iet al., 2022, Information needs and sources of information among people with depression and anxiety: a scoping review, BMC Psychiatry, Vol: 22, ISSN: 1471-244X

Background: Previous studies have identified substantial unmet information needs in people with depression and anxiety. Sufficient information about the disorder, treatment, available services, and strategies for self-management is essential as it may influence quality of care and patients’ quality of life. This scoping review aimed to provide a broad overview of information needs of people with depression and anxiety as well as the sources that they use to seek this information.Methods: We included all primary research published in English that investigated information needs or information sources in people with depression or anxiety, with no restrictions imposed on the study design, location, setting, or participant characteristics. Six electronic databases (MEDLINE, Embase, PsycINFO, CINAHL, LISTA, Web of Science) and the grey literature (Google and Google Scholar) were searched for relevant studies published up to November 2021. Two reviewers independently screened articles and extracted data. Narrative synthesis was performed to identify key themes of information needs and information sources. Factors associated with information needs/sources such as demographic variables and symptom severity were also identified.Results: Fifty-six studies (comprising 8320 participants) were included. Information needs were categorised into seven themes, including general facts, treatment, lived experience, healthcare services, coping, financial/legal, and other information. The most frequently reported needs in both people with depression and anxiety were general facts and treatment information. Subclinical samples who self-reported depressive/anxious symptoms appeared less interested in treatment information than patients with clinical diagnoses. Information sources were summarised into five categories: health professionals, written materials, media, interpersonal interactions, and organisational resources. Health professionals and media (including the internet) were th

Journal article

GBD 2019 Diabetes and Air Pollution Collaborators, 2022, Estimates, trends, and drivers of the global burden of type 2 diabetes attributable to PM2·5 air pollution, 1990-2019: an analysis of data from the Global Burden of Disease Study 2019, The Lancet Planetary Health, Vol: 6, Pages: e586-e600, ISSN: 2542-5196

BACKGROUND: Experimental and epidemiological studies indicate an association between exposure to particulate matter (PM) air pollution and increased risk of type 2 diabetes. In view of the high and increasing prevalence of diabetes, we aimed to quantify the burden of type 2 diabetes attributable to PM2·5 originating from ambient and household air pollution. METHODS: We systematically compiled all relevant cohort and case-control studies assessing the effect of exposure to household and ambient fine particulate matter (PM2·5) air pollution on type 2 diabetes incidence and mortality. We derived an exposure-response curve from the extracted relative risk estimates using the MR-BRT (meta-regression-Bayesian, regularised, trimmed) tool. The estimated curve was linked to ambient and household PM2·5 exposures from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, and estimates of the attributable burden (population attributable fractions and rates per 100 000 population of deaths and disability-adjusted life-years) for 204 countries from 1990 to 2019 were calculated. We also assessed the role of changes in exposure, population size, age, and type 2 diabetes incidence in the observed trend in PM2·5-attributable type 2 diabetes burden. All estimates are presented with 95% uncertainty intervals. FINDINGS: In 2019, approximately a fifth of the global burden of type 2 diabetes was attributable to PM2·5 exposure, with an estimated 3·78 (95% uncertainty interval 2·68-4·83) deaths per 100 000 population and 167 (117-223) disability-adjusted life-years (DALYs) per 100 000 population. Approximately 13·4% (9·49-17·5) of deaths and 13·6% (9·73-17·9) of DALYs due to type 2 diabetes were contributed by ambient PM2·5, and 6·50% (4·22-9·53) of deaths and 5·92% (3·81-8·64) of DALYs by household air pollution. High burdens, in

Journal article

Tudor Car L, Kyaw BM, Teo A, Fox TE, Vimalesvaran S, Apfelbacher C, Kemp S, Chavannes Net al., 2022, Outcomes, measurement instruments and their validity evidence in randomised trials on virtual, augmented and mixed reality in undergraduate medical education: a systematic mapping review, JMIR Serious Games, Vol: 10, ISSN: 2291-9279

Background: Extended reality, encompassing virtual, augmented and mixed reality, is increasingly used in medical education. Studies assessing effectiveness of these new educational modalities should measure relevant outcomes using outcome measurement tools with validity evidence. Our aim was to determine the choice of outcomes, measurement instruments and the use of measurement instruments with validity evidence in randomized controlled trials (RCTs) on the effectiveness of virtual reality (VR), augmented reality (AR) and mixed reality (MR) in medical student education.Methods: We conducted a systematic mapping review. We searched seven major bibliographic databases from January 1990 to April 2020. Two reviewers screened the citations and extracted data independently from the included studies. We report our findings in line with PRISMA guidelines.Results: Of 127 retrieved RCTs, 116 were on VR, eleven on AR. No RCTs on MR in medical student education were found. Of the studies on VR, 64 studies were on VR simulators, 31 studies on screen-based VR, 9 on VR patient simulations and 12 on VR serious games. Most studies reported only one outcome and immediate, post-intervention assessment data. Skills outcome was the most common outcome in studies on VR simulators, VR patient simulations and AR. Knowledge was the most common outcome in studies on screen-based VR and VR serious games. Less common outcomes included participants’ attitudes, satisfaction, cognitive or mental load, learning efficacy, engagement and/or self-efficacy beliefs, emotional state, competency developed and patient outcomes. At least one form of validity evidence was found in around half of the studies on VR simulator, VR patient simulations, VR serious games and AR, and in only a quarter of studies on screen-based VR. Most studies used assessment methods that were implemented in a non-digital format such as paper-based written exercises or in-person assessments where examiners observed performan

Journal article

Tudor Car L, 2022, Digital education for health professionals: An evidence map, conceptual framework and research agenda, Journal of Medical Internet Research, Vol: 24, Pages: 1-21, ISSN: 1438-8871

BackgroundHealth professions education has undergone major changes with the advent and adoption of digital technologies worldwide. To enable robust and relevant research in digital health professions education, it is essential to map the existing evidence, identify gaps and research priorities.MethodsWe searched for systematic reviews on digital education of practicing and student healthcare professionals. We searched Medline, Embase, Cochrane Library, ERIC, CINAHL, and grey literature sources from January 2014 to July 2020. Two authors independently screened the studies, extracted the data, and synthesized the findings. We outlined the key characteristics of the included reviews, the quality of the evidence they synthesized, and recommendations for future research. We mapped the empiric findings and research recommendations against a newly developed conceptual framework. ResultsWe identified 77 eligible systematic reviews. All included experimental studies and evaluated the effectiveness of digital education interventions in different healthcare disciplines or of different digital education modalities. Most reviews included studies on various digital education modalities (N=22), virtual reality (N=19) and online education (N=10). Most reviews focused on health professions education in general (N=36), surgery (N=13) and nursing (N=11). The reviews mainly assessed participants’ skills (N=51) and knowledge (N=49) and included data from high-income countries (N=53). Our novel conceptual framework of digital health professions education comprises six key domains (context, infrastructure, education, learners, research, and quality improvement) and 16 subdomains. Finally, we identified in these reviews 61 unique questions for future research; these mapped to framework domains of education (29 recommendations), context (17), infrastructure (9), learners (3), and research (3). Conclusions We have identified a large number of research questions regarding digital educat

Journal article

Martinengo L, Stona A-C, Car LT, Lee J, Griva K, Car Jet al., 2022, Education on Depression in Mental Health Apps: Systematic Assessment of Characteristics and Adherence to Evidence-Based Guidelines, JOURNAL OF MEDICAL INTERNET RESEARCH, Vol: 24, ISSN: 1438-8871

Journal article

Cousin E, Duncan BB, Stein C, Ong KL, Vos T, Abbafati C, Abbasi-Kangevari M, Abdelmasseh M, Abdoli A, Abd-Rabu R, Abolhassani H, Abu-Gharbieh E, Accrombessi MMK, Adnani QES, Afzal MS, Agarwal G, Agrawaal KK, Agudelo-Botero M, Ahinkorah BO, Ahmad S, Ahmad T, Ahmadi K, Ahmadi S, Ahmadi A, Ahmed A, Ahmed Salih Y, Akande-Sholabi W, Akram T, Al Hamad H, Al-Aly Z, Alcalde-Rabanal JE, Alipour V, Aljunid SM, Al-Raddadi RM, Alvis-Guzman N, Amini S, Ancuceanu R, Andrei T, Andrei CL, Anjana RM, Ansar A, Antonazzo IC, Antony B, Anyasodor AE, Arabloo J, Arizmendi D, Armocida B, Artamonov AA, Arulappan J, Aryan Z, Asgari S, Ashraf T, Astell-Burt T, Atorkey P, Atout MMW, Ayanore MA, Badiye AD, Baig AA, Bairwa M, Baker JL, Baltatu OC, Banik PC, Barnett A, Barone MTU, Barone-Adesi F, Barrow A, Bedi N, Belete R, Belgaumi UI, Bell AW, Bennett DA, Bensenor IM, Beran D, Bhagavathula AS, Bhaskar S, Bhattacharyya K, Bhojaraja VS, Bijani A, Bikbov B, Birara S, Bodolica V, Bonny A, Brenner H, Briko NI, Butt ZA, Caetano dos Santos FL, Cámera LA, Campos-Nonato IR, Cao Y, Cao C, Cerin E, Chakraborty PA, Chandan JS, Chattu VK, Chen S, Choi J-YJ, Choudhari SG, Chowdhury EK, Chu D-T, Corso B, Dadras O, Dai X, Damasceno AAM, Dandona L, Dandona R, Dávila-Cervantes CA, De Neve J-W, Denova-Gutiérrez E, Dhamnetiya D, Diaz D, Ebtehaj S, Edinur HA, Eftekharzadeh S, El Sayed I, Elgendy IY, Elhadi M, Elmonem MA, Faisaluddin M, Farooque U, Feng X, Fernandes E, Fischer F, Flood D, Freitas M, Gaal PA, Gad MM, Gaewkhiew P, Getacher L, Ghafourifard M, Ghanei Gheshlagh R, Ghashghaee A, Ghith N, Ghozali G, Gill PS, Ginawi IA, Glushkova EV, Golechha M, Gopalani SV, Guimarães RA, Gupta RD, Gupta R, Gupta VK, Gupta VB, Gupta S, Habtewold TD, Hafezi-Nejad N, Halwani R, Hanif A, Hankey GJ, Haque S, Hasaballah AI, Hasan SS, Hashi A, Hassanipour S, Hay SI, Hayat K, Heidari M, Hossain MBH, Hossain S, Hosseini M, Hoveidamanesh S, Huang J, Humayun A, Hussain R, Hwang B-F, Ibitoye SE, Ikuta KS, Inbaraj LR, Iqbal U, Islam Met al., 2022, Diabetes mortality and trends before 25 years of age: an analysis of the Global Burden of Disease Study 2019, The Lancet Diabetes & Endocrinology, Vol: 10, Pages: 177-192, ISSN: 2213-8587

BackgroundDiabetes, particularly type 1 diabetes, at younger ages can be a largely preventable cause of death with the correct health care and services. We aimed to evaluate diabetes mortality and trends at ages younger than 25 years globally using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019.MethodsWe used estimates of GBD 2019 to calculate international diabetes mortality at ages younger than 25 years in 1990 and 2019. Data sources for causes of death were obtained from vital registration systems, verbal autopsies, and other surveillance systems for 1990–2019. We estimated death rates for each location using the GBD Cause of Death Ensemble model. We analysed the association of age-standardised death rates per 100 000 population with the Socio-demographic Index (SDI) and a measure of universal health coverage (UHC) and described the variability within SDI quintiles. We present estimates with their 95% uncertainty intervals.FindingsIn 2019, 16 300 (95% uncertainty interval 14 200 to 18 900) global deaths due to diabetes (type 1 and 2 combined) occurred in people younger than 25 years and 73·7% (68·3 to 77·4) were classified as due to type 1 diabetes. The age-standardised death rate was 0·50 (0·44 to 0·58) per 100 000 population, and 15 900 (97·5%) of these deaths occurred in low to high-middle SDI countries. The rate was 0·13 (0·12 to 0·14) per 100 000 population in the high SDI quintile, 0·60 (0·51 to 0·70) per 100 000 population in the low-middle SDI quintile, and 0·71 (0·60 to 0·86) per 100 000 population in the low SDI quintile. Within SDI quintiles, we observed large variability in rates across countries, in part explained by the extent of UHC (r2=0·62). From 1990 to 2019, age-standardised death rates decreased globally by 17·0% (−

Journal article

Haowen J, Vimalesvaran S, King Wang J, Boon LK, Mogali SR, Tudor Car Let al., 2022, Virtual reality in medical students’ education: a scoping review, JMIR Medical Education, Vol: 8, Pages: 1-24, ISSN: 2369-3762

Purpose: Virtual reality (VR) is a digital education modality that produces a virtual manifestation of the real world and it has been increasingly used in medical education. As VR encompasses different modalities, tools and applications, there is a need to explore how VR has been employed in medical education. The objective of this scoping review is to map existing research on the use of VR in undergraduate medical education and to identify areas of future research.Method: We performed a search of 4 bibliographic databases in December 2020, with data extracted using a standardized data extraction form. The data was narratively synthesized and reported in line with the Joanna Briggs Institute (JBI) methodology for scoping reviews. Results: Of 114 included studies, 69 studies (61%) reported the use of commercially available surgical VR simulators. Other VR modalities included 3D models (15 [14%]) and virtual worlds (20 [18%]), mainly used for anatomy education. Most of the VR modalities included were semi-immersive (68 [60%]) and of high interactivity (79 [70%]). There is limited evidence on the use of more novel VR modalities such as mobile VR and virtual dissection tables (8 [7%]), as well as the use of VR for training of non-surgical and non-psychomotor skills (20 [18%]) or in group setting (16 [14%]). Only 3 studies reported the use conceptual frameworks or theories in the design of VR.Conclusion: Despite extensive research available on VR in medical education, there continues to be important gaps in the evidence. Future studies should explore the use of VR for the development of non-psychomotor skills and in areas other than surgery and anatomy.

Journal article

Keller R, Hartmann S, Teepe GW, Lohse K-M, Alattas A, Car LT, Muller-Riemenschneider F, von Wangenheim F, Mair JL, Kowatsch Tet al., 2022, Digital Behavior Change Interventions for the Prevention and Management of Type 2 Diabetes: Systematic Market Analysis, JOURNAL OF MEDICAL INTERNET RESEARCH, Vol: 24, ISSN: 1438-8871

Journal article

Tan BY, Thach T, Munro YL, Skou ST, Thumboo J, Car J, Car LTet al., 2021, Complex Lifestyle and Psychological Intervention in Knee Osteoarthritis: Scoping Review of Randomized Controlled Trials, INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, Vol: 18

Journal article

Ollier J, Neff S, Dworschak C, Sejdiji A, Santhanam P, Keller R, Xiao G, Asisof A, Rueegger D, Berube C, Hilfiker Tomas L, Neff J, Yao J, Alattas A, Varela-Mato V, Pitkethly A, Vara MD, Herrero R, Banos RM, Parada C, Agatheswaran RS, Villalobos V, Keller OC, Chan WS, Mishra V, Jacobson N, Stanger C, He X, von Wyl V, Weidt S, Haug S, Schaub M, Kleim B, Barth J, Witt C, Scholz U, Fleisch E, von Wangenheim F, Car LT, Mueller-Riemenschneider F, Hauser-Ulrich S, Asomoza AN, Salamanca-Sanabria A, Mair JL, Kowatsch Tet al., 2021, Elena+ Care for COVID-19, a Pandemic Lifestyle Care Intervention: Intervention Design and Study Protocol (vol 9, 625640,2021), FRONTIERS IN PUBLIC HEALTH, Vol: 9

Journal article

Car LT, Teng YS, How JW, Nazri NNBM, Tan ALX, Quah J, Peckham S, Smith Het al., 2021, Priorities for family physician and general practitioner recruitment and retention in Singapore: a PRIORITIZE study, BMC FAMILY PRACTICE, Vol: 22

Journal article

Dhinagaran DA, Sathish T, Kowatsch T, Griva K, Best JD, Tudor Car Let al., 2021, Public perceptions of diabetes, healthy living and conversational agents in Singapore: a needs assessment, JMIR Formative Research, Vol: 5, Pages: 1-15, ISSN: 2561-326X

Background:The incidence of chronic diseases such as type 2 diabetes is on the rise in countries worldwide, including Singapore. Health professional-delivered healthy lifestyle interventions have been shown to prevent type 2 diabetes. Yet ongoing personalised guidance from health professionals is not feasible or affordable at the population level. Novel digital interventions delivered using mobile technology such as conversational agents are a potential alternative for delivery of healthy lifestyle change behavioural interventions to the public.Objective:We explored Singaporeans’ perceptions on and experience of healthy living, diabetes and mobile health interventions (apps and conversational agents). This survey was done to help inform the design and development of a conversational agent focusing on healthy lifestyle change.Methods:This qualitative study was conducted over Aug and Sept 2019. 20 participants were recruited from relevant healthy living Facebook pages and groups. Semi-structured interviews were conducted in person or over the telephone using an interview guide. Interviews were transcribed and analysed in parallel by two researchers using Burnard’s method, a structured approach for thematic content analysis.Results:The collected data was organised into four main themes: (1) use of conversational agents, (2) ubiquity of smartphone applications, (3) understanding of diabetes and (4) barriers and facilitators to a healthy living in Singapore. Most participants used health-related mobile applications as well as conversational agents unrelated to healthcare. They provided diverse suggestions for future conversational agent-delivered interventions. Participants also highlighted several knowledge gaps in relation to diabetes and healthy living. In terms of barriers to healthy living, frequent dining out, high stress levels, lack of work-life balance and dearth of free time to engage in physical activity were mentioned. In contrast, discipline, pre

Journal article

Ward JL, Azzopardi PS, Francis KL, Santelli JS, Skirbekk V, Sawyer SM, Kassebaum NJ, Mokdad AH, Hay SI, Abd-Allah F, Abdoli A, Abdollahi M, Abedi A, Abolhassani H, Abreu LG, Abrigo MRM, Abu-Gharbieh E, Abushouk AI, Adebayo OM, Adekanmbi V, Adham D, Advani SM, Afshari K, Agrawal A, Ahmad T, Ahmadi K, Ahmed AE, Aji B, Akombi-Inyang B, Alahdab F, Al-Aly Z, Alam K, Alanezi FM, Alanzi TM, Alcalde-Rabanal JE, Alemu BW, Al-Hajj S, Alhassan RK, Ali S, Alicandro G, Alijanzadeh M, Aljunid SM, Almasi-Hashiani A, Almasri NA, Al-Mekhlafi HM, Alonso J, Al-Raddadi RM, Altirkawi KA, Alvis-Guzman N, Amare AT, Amini S, Aminorroaya A, Amit AML, Amugsi DA, Ancuceanu R, Anderlini D, Andrei CL, Androudi S, Ansari F, Ansari I, Antonio CAT, Anvari D, Anwer R, Appiah SCY, Arabloo J, Arab-Zozani M, Ärnlöv J, Asaad M, Asadi-Aliabadi M, Asadi-Pooya AA, Atout MMW, Ausloos M, Avenyo EK, Avila-Burgos L, Ayala Quintanilla BP, Ayano G, Aynalem YA, Azari S, Azene ZN, Bakhshaei MH, Bakkannavar SM, Banach M, Banik PC, Barboza MA, Barker-Collo SL, Bärnighausen TW, Basu S, Baune BT, Bayati M, Bedi N, Beghi E, Bekuma TT, Bell AW, Bell ML, Benjet C, Bensenor IM, Berhe AK, Berhe K, Berman AE, Bhagavathula AS, Bhardwaj N, Bhardwaj P, Bhattacharyya K, Bhattarai S, Bhutta ZA, Bijani A, Bikbov B, Biondi A, Birhanu TTM, Biswas RK, Bohlouli S, Bolla SR, Boloor A, Borschmann R, Boufous S, Bragazzi NL, Braithwaite D, Breitborde NJK, Brenner H, Britton GB, Burns RA, Burugina Nagaraja S, Butt ZA, Caetano dos Santos FL, Cámera LA, Campos-Nonato IR, Campuzano Rincon JC, Cárdenas R, Carreras G, Carrero JJ, Carvalho F, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Catalá-López F, Cerin E, Chandan JS, Chang H-Y, Chang J-C, Charan J, Chattu VK, Chaturvedi S, Choi J-YJ, Chowdhury MAK, Christopher DJ, Chu D-T, Chung MT, Chung S-C, Cicuttini FM, Constantin TV, Costa VM, Dahlawi SMA, Dai H, Dai X, Damiani G, Dandona L, Dandona R, Daneshpajouhnejad P, Darwesh AM, Dávila-Cervantes CA, Davletov K, De la Hoz FP, De Let al., 2021, Global, regional, and national mortality among young people aged 10–24 years, 1950–2019: a systematic analysis for the Global Burden of Disease Study 2019, The Lancet, Vol: 398, Pages: 1593-1618, ISSN: 0140-6736

BackgroundDocumentation of patterns and long-term trends in mortality in young people, which reflect huge changes in demographic and social determinants of adolescent health, enables identification of global investment priorities for this age group. We aimed to analyse data on the number of deaths, years of life lost, and mortality rates by sex and age group in people aged 10–24 years in 204 countries and territories from 1950 to 2019 by use of estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019.MethodsWe report trends in estimated total numbers of deaths and mortality rate per 100 000 population in young people aged 10–24 years by age group (10–14 years, 15–19 years, and 20–24 years) and sex in 204 countries and territories between 1950 and 2019 for all causes, and between 1980 and 2019 by cause of death. We analyse variation in outcomes by region, age group, and sex, and compare annual rate of change in mortality in young people aged 10–24 years with that in children aged 0–9 years from 1990 to 2019. We then analyse the association between mortality in people aged 10–24 years and socioeconomic development using the GBD Socio-demographic Index (SDI), a composite measure based on average national educational attainment in people older than 15 years, total fertility rate in people younger than 25 years, and income per capita. We assess the association between SDI and all-cause mortality in 2019, and analyse the ratio of observed to expected mortality by SDI using the most recent available data release (2017).FindingsIn 2019 there were 1·49 million deaths (95% uncertainty interval 1·39–1·59) worldwide in people aged 10–24 years, of which 61% occurred in males. 32·7% of all adolescent deaths were due to transport injuries, unintentional injuries, or interpersonal violence and conflict; 32·1% were due to communicable, nutritional, or mater

Journal article

Ollier J, Neff S, Dworschak C, Sejdiji A, Santhanam P, Keller R, Xiao G, Asisof A, Ruegger D, Berube C, Tomas LH, Neff J, Yao J, Alattas A, Varela-Mato V, Pitkethly A, Vara MD, Herrero R, Banos RM, Parada C, Agatheswaran RS, Villalobos V, Keller OC, Chan WS, Mishra V, Jacobson N, Stanger C, He X, von Wyl V, Weidt S, Haug S, Schaub M, Kleim B, Barth J, Witt C, Scholz U, Fleisch E, von Wangenheim F, Car LT, Mueller-Riemenschneider F, Hauser-Ulrich S, Nunez Asomoza A, Salamanca-Sanabria A, Mair JL, Kowatsch Tet al., 2021, Elena plus Care for COVID-19, a Pandemic Lifestyle Care Intervention: Intervention Design and Study Protocol, FRONTIERS IN PUBLIC HEALTH, Vol: 9

Journal article

Micah AE, Cogswell IE, Cunningham B, Ezoe S, Harle AC, Maddison ER, McCracken D, Nomura S, Simpson KE, Stutzman HN, Tsakalos G, Wallace LE, Zhao Y, Zende RR, Abbafati C, Abdelmasseh M, Abedi A, Abegaz KH, Abhilash ES, Abolhassani H, Abrigo MRM, Adhikari TB, Afzal S, Ahinkorah BO, Ahmadi S, Ahmed H, Ahmed MB, Ahmed Rashid T, Ajami M, Aji B, Akalu Y, Akunna CJ, Al Hamad H, Alam K, Alanezi FM, Alanzi TM, Alemayehu Y, Alhassan RK, Alinia C, Aljunid SM, Almustanyir SA, Alvis-Guzman N, Alvis-Zakzuk NJ, Amini S, Amini-Rarani M, Amu H, Ancuceanu R, Andrei CL, Andrei T, Angell B, Anjomshoa M, Antonio CAT, Antony CM, Aqeel M, Arabloo J, Arab-Zozani M, Aripov T, Arrigo A, Ashraf T, Atnafu DD, Ausloos M, Avila-Burgos L, Awan AT, Ayano G, Ayanore MA, Azari S, Azhar GS, Babalola TK, Bahrami MA, Baig AA, Banach M, Barati N, Bärnighausen TW, Barrow A, Basu S, Baune BT, Bayati M, Benzian H, Berman AE, Bhagavathula AS, Bhardwaj N, Bhardwaj P, Bhaskar S, Bibi S, Bijani A, Bodolica V, Bragazzi NL, Braithwaite D, Breitborde NJK, Breusov AV, Briko NI, Busse R, Cahuana-Hurtado L, Callander EJ, Cámera LA, Castañeda-Orjuela CA, Catalá-López F, Charan J, Chatterjee S, Chattu SK, Chattu VK, Chen S, Cicero AFG, Dadras O, Dahlawi SMA, Dai X, Dalal K, Dandona L, Dandona R, Davitoiu DV, De Neve J-W, de Sá-Junior AR, Denova-Gutiérrez E, Dhamnetiya D, Dharmaratne SD, Doshmangir L, Dube J, Ehsani-Chimeh E, El Sayed Zaki M, El Tantawi M, Eskandarieh S, Farzadfar F, Ferede TY, Fischer F, Foigt NA, Freitas A, Friedman SD, Fukumoto T, Fullman N, Gaal PA, Gad MM, Garcia-Gordillo MA, Garg T, Ghafourifard M, Ghashghaee A, Gholamian A, Gholamrezanezhad A, Ghozali G, Gilani SA, Glăvan I-R, Glushkova EV, Goharinezhad S, Golechha M, Goli S, Guha A, Gupta VB, Gupta VK, Haakenstad A, Haider MR, Hailu A, Hamidi S, Hanif A, Harapan H, Hartono RK, Hasaballah AI, Hassan S, Hassanein MH, Hayat K, Hegazy MI, Heidari G, Hendrie D, Heredia-Pi I, Herteliu C, Hezam K, Holla R, Hossain SJ, Hosseinzadeh M, Hostiuc S, Huda Tet al., 2021, Tracking development assistance for health and for COVID-19: a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990–2050, The Lancet, Vol: 398, Pages: 1317-1343, ISSN: 0140-6736

BackgroundThe rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020.MethodsWe estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$ per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050.FindingsIn 2019, health spending globally reached $8·8 trillion (95% uncertainty interval [UI] 8·7–8·8) or $1132 (1119–1143) per person. Spending on health varied within and across income groups and geogra

Journal article

Teepe GW, Da Fonseca A, Kleim B, Jacobson NC, Sanabria AS, Car LT, Fleisch E, Kowatsch Tet al., 2021, Just-in-Time Adaptive Mechanisms of Popular Mobile Apps for Individuals With Depression: Systematic App Search and Literature Review, JOURNAL OF MEDICAL INTERNET RESEARCH, Vol: 23, ISSN: 1438-8871

Journal article

Paulson KR, Kamath AM, Alam T, Bienhoff K, Abady GG, Abbas J, Abbasi-Kangevari M, Abbastabar H, Abd-Allah F, Abd-Elsalam SM, Abdoli A, Abedi A, Abolhassani H, Abreu LG, Abu-Gharbieh E, Abu-Rmeileh NME, Abushouk AI, Adamu AL, Adebayo OM, Adegbosin AE, Adekanmbi V, Adetokunboh OO, Adeyinka DA, Adsuar JC, Afshari K, Aghaali M, Agudelo-Botero M, Ahinkorah BO, Ahmad T, Ahmadi K, Ahmed MB, Aji B, Akalu Y, Akinyemi OO, Aklilu A, Al-Aly Z, Alam K, Alanezi FM, Alanzi TM, Alcalde-Rabanal JE, Al-Eyadhy A, Ali T, Alicandro G, Alif SM, Alipour V, Alizade H, Aljunid SM, Almasi-Hashiani A, Almasri NA, Al-Mekhlafi HM, Alonso J, Al-Raddadi RM, Altirkawi KA, Alumran AK, Alvis-Guzman N, Alvis-Zakzuk NJ, Ameyaw EK, Amini S, Amini-Rarani M, Amit AML, Amugsi DA, Ancuceanu R, Anderlini D, Andrei CL, Ansari F, Ansari-Moghaddam A, Antonio CAT, Antriyandarti E, Anvari D, Anwer R, Aqeel M, Arabloo J, Arab-Zozani M, Aripov T, Ärnlöv J, Artanti KD, Arzani A, Asaad M, Asadi-Aliabadi M, Asadi-Pooya AA, Asghari Jafarabadi M, Athari SS, Athari SM, Atnafu DD, Atreya A, Atteraya MS, Ausloos M, Awan AT, Ayala Quintanilla BP, Ayano G, Ayanore MA, Aynalem YA, Azari S, Azarian G, Azene ZN, B DB, Babaee E, Badiye AD, Baig AA, Banach M, Banik PC, Barker-Collo SL, Barqawi HJ, Bassat Q, Basu S, Baune BT, Bayati M, Bedi N, Beghi E, Beghi M, Bell ML, Bendak S, Bennett DA, Bensenor IM, Berhe K, Berman AE, Bezabih YM, Bhagavathula AS, Bhandari D, Bhardwaj N, Bhardwaj P, Bhattacharyya K, Bhattarai S, Bhutta ZA, Bikbov B, Biondi A, Birihane BM, Biswas RK, Bohlouli S, Bragazzi NL, Breusov AV, Brunoni AR, Burkart K, Burugina Nagaraja S, Busse R, Butt ZA, Caetano dos Santos FL, Cahuana-Hurtado L, Camargos P, Cámera LA, Cárdenas R, Carreras G, Carrero JJ, Carvalho F, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Cerin E, Chang J-C, Chanie WF, Charan J, Chatterjee S, Chattu SK, Chattu VK, Chaturvedi S, Chen S, Cho DY, Choi J-YJ, Chu D-T, Ciobanu LG, Cirillo M, Conde J, Costa VM, Couto RAS, Dachew BA, Dahlaet al., 2021, Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019, The Lancet, Vol: 398, Pages: 870-905, ISSN: 0140-6736

BackgroundSustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival.MethodsWe completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (U5MR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index.FindingsGlobal U5MR decreased from 71·2 deaths per 1000 livebirths (95% uncertainty interval [UI] 68·3–74·0) in 2000 to 37·1 (33·2–41·7) in 2019 while global NMR correspondingly declined more slowly from 28·0 deaths per 1000 live births (26·8–29·5) in 2000 to 17·9 (16·3–19·8) in 2019.

Journal article

Kingsland M, Barnes C, Doherty E, McCrabb S, Finch M, Cumpston M, Armstrong R, Car LT, Doyle J, Wolfenden Let al., 2021, Identifying topics for future Cochrane Public Health reviews, JOURNAL OF PUBLIC HEALTH, ISSN: 1741-3842

Journal article

Tudor Car L, 2021, The choice of behavioral change techniques in conversational agents in healthcare: a scoping review protocol, JMIR Research Protocols, Vol: 10, Pages: 1-5, ISSN: 1929-0748

Background:Conversational agents or chatbots are computer programs that simulate conversations with users. Conversational agents are increasingly used for delivery of behavior change interventions in health care. Behavior change is complex and comprises the use of one or several components collectively known as behavioral change techniques (BCTs).Objective:The objective of this scoping review is to identify the BCTs that are used in behavior change–focused interventions delivered via conversational agents in health care.Methods:This scoping review will be performed in line with the Joanna Briggs Institute methodology and will be reported according to the PRISMA extension for scoping reviews guidelines. We will perform a comprehensive search of electronic databases and grey literature sources, and will check the reference lists of included studies for additional relevant studies. The screening and data extraction will be performed independently and in parallel by two review authors. Discrepancies will be resolved through consensus or discussion with a third review author. We will use a data extraction form congruent with the key themes and aims of this scoping review. BCTs employed in the included studies will be coded in line with BCT Taxonomy v1. We will analyze the data qualitatively and present it in diagrammatic or tabular form, alongside a narrative summary.Results:To date, we have designed the search strategy and performed the search on April 26, 2021. The first round of screening of retrieved articles is planned to begin soon.Conclusions:Using appropriate BCTs in the design and delivery of health care interventions via conversational agents is essential to improve long-term outcomes. Our findings will serve to inform the development of future interventions in this area.International Registered Report Identifier (IRRID):PRR1-10.2196/30166JMIR Res Protoc 2021;10(7):e30166

Journal article

Tudor Car L, Myint Kyaw B, Nannan Panday RS, van der Kleij R, Chavannes N, Majeed A, Car Jet al., 2021, Digital health training programs for medical students: a scoping review, Journal of Medical Internet Research, Vol: 7, Pages: 1-11, ISSN: 1438-8871

Background: Medical schools worldwide are accelerating the introduction of digital health courses into their curricula. This review collated and analyzed the literature evaluating digital health education for medical students to inform development of future courses and identify areas where curricula may need to be strengthened.Methods: We carried out a scoping review following the Joanna Briggs Institute’s guidance and reported in line with PRISMA-ScR guidelines. We searched six major bibliographic databases and grey literature sources for the articles published from January 2000 to November 2019. Two authors independently screened the retrieved citations and extracted the data from the included studies. Discrepancies were resolved by consensus discussion between the authors. The findings were analyzed using thematic analysis and presented narratively.Results: A total of 34 studies focusing on different digital courses were included in this review. Most (n=22) were published from 2010 to 2019 and originated from the US (n=20). The reported digital health courses were mostly elective (n=20), integrated into the existing curriculum (n=24) and focused mainly on medical informatics (n=17). Most of the courses targeted medical students from first to third year (n=17) and the duration of the courses ranged from an hour to three academic years. Most (n=22) reported the use of blended education. Six of 34 delivered courses entirely digitally using online modules, offline learning, Massive Open Online Courses, and virtual patient simulations. The reported courses used various assessment approaches such as paper-based assessments, in person observations and/or online-based assessment. Thirty studies evaluated courses mostly using uncontrolled before and after design and generally reported improvements in students’ learning outcomes. ConclusionsDigital health courses reported in the literature were mostly elective, focused on a single area of digital health and lac

Journal article

See YKC, Smith HE, Car LT, Protheroe J, Wong WC, Bartlam Bet al., 2021, Health literacy and health outcomes in patients with low back pain: a scoping review, BMC MEDICAL INFORMATICS AND DECISION MAKING, Vol: 21

Journal article

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