Publications
176 results found
Wolfenden L, Close S, Finch M, et al., 2023, Improving academic and public health impact of Cochrane public health reviews: what can we learn from bibliographic metrics and author dissemination strategies? A cross-sectional study., J Public Health (Oxf), Vol: 45, Pages: e577-e586
BACKGROUND: To facilitate the development of impactful research dissemination strategies, this study aimed to: (i) survey authors of trials included in a sample of Cochrane reviews to describe strategies to disseminate trial findings, and examine their association with academic and policy impacts and (ii) audit academic and policy impact of CPH reviews. METHODS: Authors of 104 trials within identified Cochrane reviews completed survey items assessing the dissemination strategies. Field weighted citation (FWCI) data extracted from bibliographic databases served as a measure of academic impact of trials and CPH reviews. Policy and practice impacts of trials were assessed during the survey of trial authors using items based on the Payback Framework, and for CPH reviews using 'policy mention' data collected via Altmetric Explorer. RESULTS: Among the included trials, univariate (but not multivariable) regression models revealed significant associations between the use of dissemination strategies (i.e. posts on social media; workshops with end-users; media-releases) and policy or practice impacts. No significant associations were reported between dissemination strategies and trial FWCI. The mean FWCI of CPH reviews suggest that they are cited 220% more than other reviews in their field. CONCLUSIONS: Comprehensive dissemination strategies are likely required to maximize the potential the potential impacts of public health research.
Lin X, Martinengo L, Jabir AI, et al., 2023, Scope, Characteristics, Behavior Change Techniques, and Quality of Conversational Agents for Mental Health and Well-Being: Systematic Assessment of Apps., J Med Internet Res, Vol: 25
BACKGROUND: Mental disorders cause substantial health-related burden worldwide. Mobile health interventions are increasingly being used to promote mental health and well-being, as they could improve access to treatment and reduce associated costs. Behavior change is an important feature of interventions aimed at improving mental health and well-being. There is a need to discern the active components that can promote behavior change in such interventions and ultimately improve users' mental health. OBJECTIVE: This study systematically identified mental health conversational agents (CAs) currently available in app stores and assessed the behavior change techniques (BCTs) used. We further described their main features, technical aspects, and quality in terms of engagement, functionality, esthetics, and information using the Mobile Application Rating Scale. METHODS: The search, selection, and assessment of apps were adapted from a systematic review methodology and included a search, 2 rounds of selection, and an evaluation following predefined criteria. We conducted a systematic app search of Apple's App Store and Google Play using 42matters. Apps with CAs in English that uploaded or updated from January 2020 and provided interventions aimed at improving mental health and well-being and the assessment or management of mental disorders were tested by at least 2 reviewers. The BCT taxonomy v1, a comprehensive list of 93 BCTs, was used to identify the specific behavior change components in CAs. RESULTS: We found 18 app-based mental health CAs. Most CAs had <1000 user ratings on both app stores (12/18, 67%) and targeted several conditions such as stress, anxiety, and depression (13/18, 72%). All CAs addressed >1 mental disorder. Most CAs (14/18, 78%) used cognitive behavioral therapy (CBT). Half (9/18, 50%) of the CAs identified were rule based (ie, only offered predetermined answers) and the other half (9/18, 50%) were artificial intelligence enhanced (ie, included o
Ng MSP, Jabir AI, Ng TDR, et al., 2023, Evaluating TESLA-G, a gamified, telegram-delivered, quizzing platform for surgical education in medical students: protocol for a pilot randomised controlled trial., BMJ Open, Vol: 13
INTRODUCTION: 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. METHODS AND ANALYSIS: This online, pilot randomised control trial will be conducted over 2 weeks. Fifty full-time undergraduate medical students from a medical school in Singapore 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.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 five 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. The feasibility of this pilot study will be determined quantitatively by participant enrolment, participant retention and degree of completion of the quizzes. The acceptability of the intervention will be assessed quantitatively by a postintervention learner satisfaction survey consisting of a system satisfaction questionnaire and a content satisfaction questionnaire. The improvement of surgical knowledge will be assessed by comparing the scores of preintervention and postintervention knowledge tests, which consist of separately created questions on endocrine surgery. Retention of surgical knowledge will be measured using a follow-u
Momtazmanesh S, Moghaddam SS, Ghamari SH, et al., 2023, Global burden of chronic respiratory diseases and risk factors, 1990–2019: an update from the Global Burden of Disease Study 2019, eClinicalMedicine, Vol: 59
Background: Updated data on chronic respiratory diseases (CRDs) are vital in their prevention, control, and treatment in the path to achieving the third UN Sustainable Development Goals (SDGs), a one-third reduction in premature mortality from non-communicable diseases by 2030. We provided global, regional, and national estimates of the burden of CRDs and their attributable risks from 1990 to 2019. Methods: Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we estimated mortality, years lived with disability, years of life lost, disability-adjusted life years (DALYs), prevalence, and incidence of CRDs, i.e. chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease and pulmonary sarcoidosis, and other CRDs, from 1990 to 2019 by sex, age, region, and Socio-demographic Index (SDI) in 204 countries and territories. Deaths and DALYs from CRDs attributable to each risk factor were estimated according to relative risks, risk exposure, and the theoretical minimum risk exposure level input. Findings: In 2019, CRDs were the third leading cause of death responsible for 4.0 million deaths (95% uncertainty interval 3.6–4.3) with a prevalence of 454.6 million cases (417.4–499.1) globally. While the total deaths and prevalence of CRDs have increased by 28.5% and 39.8%, the age-standardised rates have dropped by 41.7% and 16.9% from 1990 to 2019, respectively. COPD, with 212.3 million (200.4–225.1) prevalent cases, was the primary cause of deaths from CRDs, accounting for 3.3 million (2.9–3.6) deaths. With 262.4 million (224.1–309.5) prevalent cases, asthma had the highest prevalence among CRDs. The age-standardised rates of all burden measures of COPD, asthma, and pneumoconiosis have reduced globally from 1990 to 2019. Nevertheless, the age-standardised rates of incidence and prevalence of interstitial lung disease and pulmonary sarcoidosis have increased throughout this pe
Jabir AI, Martinengo L, Lin X, et al., 2023, Evaluating Conversational Agents for Mental Health: Scoping Review of Outcomes and Outcome Measurement Instruments., J Med Internet Res, Vol: 25
BACKGROUND: Rapid proliferation of mental health interventions delivered through conversational agents (CAs) calls for high-quality evidence to support their implementation and adoption. Selecting appropriate outcomes, instruments for measuring outcomes, and assessment methods are crucial for ensuring that interventions are evaluated effectively and with a high level of quality. OBJECTIVE: We aimed to identify the types of outcomes, outcome measurement instruments, and assessment methods used to assess the clinical, user experience, and technical outcomes in studies that evaluated the effectiveness of CA interventions for mental health. METHODS: We undertook a scoping review of the relevant literature to review the types of outcomes, outcome measurement instruments, and assessment methods in studies that evaluated the effectiveness of CA interventions for mental health. We performed a comprehensive search of electronic databases, including PubMed, Cochrane Central Register of Controlled Trials, Embase (Ovid), PsychINFO, and Web of Science, as well as Google Scholar and Google. We included experimental studies evaluating CA mental health interventions. The screening and data extraction were performed independently by 2 review authors in parallel. Descriptive and thematic analyses of the findings were performed. RESULTS: We included 32 studies that targeted the promotion of mental well-being (17/32, 53%) and the treatment and monitoring of mental health symptoms (21/32, 66%). The studies reported 203 outcome measurement instruments used to measure clinical outcomes (123/203, 60.6%), user experience outcomes (75/203, 36.9%), technical outcomes (2/203, 1.0%), and other outcomes (3/203, 1.5%). Most of the outcome measurement instruments were used in only 1 study (150/203, 73.9%) and were self-reported questionnaires (170/203, 83.7%), and most were delivered electronically via survey platforms (61/203, 30.0%). No validity evidence was cited for more than half of the outco
Lee M, Bin Mahmood ABS, Lee ES, et al., 2023, Smartphone and Mobile App Use Among Physicians in Clinical Practice: Scoping Review., JMIR Mhealth Uhealth, Vol: 11
BACKGROUND: Health care professionals are increasingly using smartphones in clinical care. Smartphone use can affect patient quality of care and clinical outcomes. OBJECTIVE: This scoping review aimed to describe how physicians use smartphones and mobile apps in clinical settings. METHODS: We conducted a scoping review using the Joanna Briggs Institute methodology and reported the results according to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. We used the following databases in our literature search: MEDLINE, Embase, Cochrane Library, Web of Science, Google Scholar, and gray literature for studies published since 2010. An additional search was also performed by scanning the reference lists of included studies. A narrative synthesis approach was used. RESULTS: A total of 10 studies, published between 2016 and 2021, were included in this review. Of these studies, 8 used surveys and 2 used surveys with focus group study designs to explore smartphone use, its adoption, experience of using it, and views on the use of smartphones among physicians. There were studies with only general practitioners (n=3), studies with only specialists (n=3), and studies with both general practitioners and specialists (n=4). Physicians use smartphones and mobile apps for communication (n=9), clinical decision-making (n=7), drug compendium (n=7), medical education and training (n=7), maintaining health records (n=4), managing time (n=4), and monitoring patients (n=2) in clinical practice. The Medscape medical app was frequently used for information gathering. WhatsApp, a nonmedical app, was commonly used for physician-patient communication. The commonly reported barriers were lack of regulatory oversight, privacy concerns, and limited Wi-Fi or internet access. The commonly reported facilitator was convenience and having access to evidence-based medicine, clinical decision-making support, and a wide array of apps.
Salamanca-Sanabria A, Jabir AI, Lin X, et al., 2023, Exploring the Perceptions of mHealth Interventions for the Prevention of Common Mental Disorders in University Students in Singapore: Qualitative Study., J Med Internet Res, Vol: 25
BACKGROUND: Mental health interventions delivered through mobile health (mHealth) technologies can increase the access to mental health services, especially among university students. The development of mHealth intervention is complex and needs to be context sensitive. There is currently limited evidence on the perceptions, needs, and barriers related to these interventions in the Southeast Asian context. OBJECTIVE: This qualitative study aimed to explore the perception of university students and mental health supporters in Singapore about mental health services, campaigns, and mHealth interventions with a focus on conversational agent interventions for the prevention of common mental disorders such as anxiety and depression. METHODS: We conducted 6 web-based focus group discussions with 30 university students and one-to-one web-based interviews with 11 mental health supporters consisting of faculty members tasked with student pastoral care, a mental health first aider, counselors, psychologists, a clinical psychologist, and a psychiatrist. The qualitative analysis followed a reflexive thematic analysis framework. RESULTS: The following 6 main themes were identified: a healthy lifestyle as students, access to mental health services, the role of mental health promotion campaigns, preferred mHealth engagement features, factors that influence the adoption of mHealth interventions, and cultural relevance of mHealth interventions. The interpretation of our findings shows that students were reluctant to use mental health services because of the fear of stigma and a possible lack of confidentiality. CONCLUSIONS: Study participants viewed mHealth interventions for mental health as part of a blended intervention. They also felt that future mental health mHealth interventions should be more personalized and capable of managing adverse events such as suicidal ideation.
Tudor Car L, 2023, Smartphone apps for point-of-care information summaries: systematic assessment of the quality and content, BMJ Evidence-Based Medicine, ISSN: 2515-446X
Background Clinicians need easy access to evidence-based information to inform their clinical practice. Point-of-care information summaries are increasingly available in the form of smartphone apps. However, the quality of information from the apps is questionable as there is currently no regulation on the content of the medical apps.Objectives This study aimed to systematically assess the quality and content of the medical apps providing point-of-care information summaries that were available in two major app stores. We evaluated apps designed specifically for healthcare professionals and assessed their content development, editorial policy, coverage of medical conditions and trustworthiness.Methods We conducted a systematic assessment of medical apps providing point-of-care information summaries available in Google Play and Apple app stores. Apps launched or updated since January 2020 were identified through a systematic search using 42matters. Apps meeting the inclusion criteria were downloaded and assessed. The data extraction and app assessment were done in parallel and independently by at least two reviewers. Apps were evaluated against the adapted criteria: (1) general characteristics, (2) content presentation of the summaries, (3) editorial quality, (4) evidence-based methodology, (5) coverage (volume) of the medical conditions, (6) usability of apps and (7) trustworthiness of the app based on HONcode principles. HONcode principles are guidelines used to inform users about the credibility and reliability of health information online. The results were reported as a narrative review.Results Eight medical apps met the inclusion criteria and were systematically appraised. Based on our evaluation criteria, UpToDate supported 16 languages, and all other apps were English. Bullet points and brief paragraphs were used in all apps, and only DynaMed and Micromedex and Pathway-medical knowledge provided a formal grading system for the strength of recommendations for al
Global Burden of Disease 2021 Health Financing Collaborator Network, 2023, Global investments in pandemic preparedness and COVID-19: development assistance and domestic spending on health between 1990 and 2026, The Lancet Global Health, Vol: 11, Pages: e385-e413, ISSN: 2214-109X
BACKGROUND: The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevention, and treatment globally. Among the many factors that might have led to these gaps is the issue of the financing of national health systems, especially in low-income and middle-income countries (LMICs), as well as a robust global system for pandemic preparedness. We aimed to provide a comparative assessment of global health spending at the onset of the pandemic; characterise the amount of development assistance for pandemic preparedness and response disbursed in the first 2 years of the COVID-19 pandemic; and examine expectations for future health spending and put into context the expected need for investment in pandemic preparedness. METHODS: In this analysis of global health spending between 1990 and 2021, and prediction from 2021 to 2026, we estimated four sources of health spending: development assistance for health (DAH), government spending, out-of-pocket spending, and prepaid private spending across 204 countries and territories. We used the Organisation for Economic Co-operation and Development (OECD)'s Creditor Reporting System (CRS) and the WHO Global Health Expenditure Database (GHED) to estimate spending. We estimated development assistance for general health, COVID-19 response, and pandemic preparedness and response using a keyword search. Health spending estimates were combined with estimates of resources needed for pandemic prevention and preparedness to analyse future health spending patterns, relative to need. FINDINGS: In 2019, at the onset of the COVID-19 pandemic, US$9·2 trillion (95% uncertainty interval [UI] 9·1-9·3) was spent on health worldwide. We found great disparities in the amount of resources devoted to health, with high-income countries spending $7·3 trillion (95% UI 7·2-7·4) in 2019; 293·7 times the $24·8 billion (95% UI 24·3-25·3) spent by low-income countries in 20
Castro O, Mair JL, Salamanca-Sanabria A, et al., 2023, Development of "LvL UP 1.0": a smartphone-based, conversational agent-delivered holistic lifestyle intervention for the prevention of non-communicable diseases and common mental disorders., Front Digit Health, Vol: 5
BACKGROUND: Non-communicable diseases (NCDs) and common mental disorders (CMDs) are the leading causes of death and disability worldwide. Lifestyle interventions via mobile apps and conversational agents present themselves as low-cost, scalable solutions to prevent these conditions. This paper describes the rationale for, and development of, "LvL UP 1.0″, a smartphone-based lifestyle intervention aimed at preventing NCDs and CMDs. MATERIALS AND METHODS: A multidisciplinary team led the intervention design process of LvL UP 1.0, involving four phases: (i) preliminary research (stakeholder consultations, systematic market reviews), (ii) selecting intervention components and developing the conceptual model, (iii) whiteboarding and prototype design, and (iv) testing and refinement. The Multiphase Optimization Strategy and the UK Medical Research Council framework for developing and evaluating complex interventions were used to guide the intervention development. RESULTS: Preliminary research highlighted the importance of targeting holistic wellbeing (i.e., both physical and mental health). Accordingly, the first version of LvL UP features a scalable, smartphone-based, and conversational agent-delivered holistic lifestyle intervention built around three pillars: Move More (physical activity), Eat Well (nutrition and healthy eating), and Stress Less (emotional regulation and wellbeing). Intervention components include health literacy and psychoeducational coaching sessions, daily "Life Hacks" (healthy activity suggestions), breathing exercises, and journaling. In addition to the intervention components, formative research also stressed the need to introduce engagement-specific components to maximise uptake and long-term use. LvL UP includes a motivational interviewing and storytelling approach to deliver the coaching sessions, as well as progress feedback and gamification. Offline materials are also offered to allow users access to essential intervent
Tan JW, Chong DKS, Ng KB, et al., 2023, Rehearsal-based digital serious boardgame versus a game-free e-learning tool for anatomical education: Quasi-randomized controlled trial., Anat Sci Educ, Vol: 16, Pages: 830-842
Serious games may resolve problems relating to low motivation in complex medical topics such as anatomy. However, they remain relatively novel introductions to the science of learning, and further research is required to ascertain their benefits. This study describes the overall development and testing of a digital serious boardgame designed to facilitate the rehearsal of musculoskeletal anatomy based on self-determination theory with considerations for the psychological state of Flow. It was hypothesized that students assigned to the intervention game condition would attain higher Flow scores, a measure of engagement and intrinsic motivation, than students assigned to the game-free control, and that the intervention condition would report either superior or non-superior, but not inferior, scores on a surprise recall test. A total of 36 second-year undergraduate medical students participated in the quasi-randomized controlled trial, where the intervention groups went first and randomly drew questions that were mirrored into the control groups. All students were administered an identical 10-question baseline assessment before their interventions, the Short Flow Scale immediately after, and a surprise test four-to-six weeks later. Independent samples t-tests indicated that students of both conditions were of similar baseline knowledge (t = 0.7, p = 0.47), significantly higher Flow scores in the game condition (t = 2.99, p = 0.01), and no significant differences between surprise test scores (t = -0.3, p = 0.75). The game appears to be an appropriate game-based tool for student rehearsal of anatomical education, stemming from a strong theoretical base that facilitates high engagement and intrinsic motivation.
Kingsland M, Barnes C, Doherty E, et al., 2022, Identifying topics for future Cochrane Public Health reviews, JOURNAL OF PUBLIC HEALTH, Vol: 44, Pages: E578-E581, ISSN: 1741-3842
Soon CSL, Car LT, Ng CJ, et al., 2022, What Is the Utility of Posters? Qualitative Study of Participants at a Regional Primary Healthcare Conference in Asia, MEDICAL SCIENCE EDUCATOR, Vol: 32, Pages: 1405-1412
Chan FHF, Goh ZZS, Zhu X, et al., 2022, Subjective cognitive complaints in end-stage renal disease: a systematic review and meta-analysis, HEALTH PSYCHOLOGY REVIEW, ISSN: 1743-7199
Martinengo L, Jabir AI, Goh WWT, et 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
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
Subramaniam M, Lau JH, Asharani P, et 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
Dhinagaran DA, Martinengo L, Ho M-HR, et al., 2022, Designing, Developing, Evaluating, and Implementing a Smartphone-Delivered, Rule-Based Conversational Agent (DISCOVER): Development of a Conceptual Framework, JMIR MHEALTH AND UHEALTH, Vol: 10, ISSN: 2291-5222
Soon MKS, Martinengo L, Lu J, et 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.
Peng Ng MS, Jabir AI, De Rong Ng T, et 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
Chen S, Sam XH, Soong A, et al., 2022, Recruitment of general practitioners in China: a scoping review of strategies and challenges, BMC PRIMARY CARE, Vol: 23
Tudor Car L, Chan FHF, Lin X, et 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
Salamanca-Sanabria A, Castro O, Alattas A, et al., 2022, Top-Funded Companies Offering Digital Health Interventions for the Prevention and Treatment of Depression: A Systematic Market Analysis (Preprint)
<sec> <title>BACKGROUND</title> <p>Digital innovations in the mental health care field provide an opportunity to mitigate the global burden of mental disorders such as depression by facilitating timely, accessible, scalable, and affordable interventions. However, there is little evidence on how much these interventions rely on novel automated approaches, such as conversational agents (CAS), just-in-time adaptive interventions (JITAIs), or low-burden sensing technologies.</p> </sec> <sec> <title>OBJECTIVE</title> <p>Our objectives were: (i) to identify the top-funded companies offering digital health interventions for the prevention and treatment of depression (DHID), (ii) to review DHIDs’ scientific evidence, (iii) to identify which psychotherapy approaches are being used, and (iv) to examine the degree to which these DHIDs include novel automated approaches such as CAs, JITAIs, and low-burden sensing technologies.</p> </sec> <sec> <title>METHODS</title> <p>A systematic search was conducted using two venture capital databases (Crunchbase and Pitchbook) to identify the top 30 funded companies offering DHIDs. In addition, studies related to the DHIDs were identified via scientific databases (PubMed, Cochrane Library, and APA Psych-info) and hand-searching (companies’ websites).</p> </sec> <sec> <title>RESULTS</title> <p>The top-30 funded companies offering DHIDs received total funding of 2’592 billion USD up to February 2022. A total of 83 studies were identified by fewer than half of the companies (n=14; 46.6%), of whic
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
Martinengo L, Jabir AI, Goh WWT, et al., 2022, Conversational agents in healthcare: a scoping review of their behavior change techniques and underpinning theory (Preprint)
<sec> <title>BACKGROUND</title> <p>Conversational agents (CAs) are increasingly used in healthcare to deliver behavior change interventions. Their evaluation often includes categorizing the behavior change techniques (BCTs), using a classification system of which the BCT Taxonomy V1 is one of the most common. Previous studies have presented descriptive summaries of behavior change interventions delivered by CAs, but no in-depth study reporting the use of BCTs in these interventions has been published to date.</p> </sec> <sec> <title>OBJECTIVE</title> <p>We aimed to describe behavior change interventions delivered by CAs and identify the behavior change techniques (BCTs) and theories guiding their design.</p> </sec> <sec> <title>METHODS</title> <p>We searched PubMed, Embase, Cochrane’s CENTRAL, and the first ten pages of Google and Google Scholar in April 2021. We included primary, experimental studies evaluating a behavior change intervention delivered by a CA. BCTs coding followed the BCT Taxonomy v1. Two independent reviewers selected the studies and extracted the data. Descriptive analysis and frequent itemset mining to identify BCT clusters were performed. </p> </sec> <sec> <title>RESULTS</title> <p>We included 47 studies reporting on mental health (n=19, 40%), chronic disorders (n=14, 30%), and lifestyle change (n=14, 30%) interventions. There were 20 embodied CAs (43%) and 27 CAs (57%) represented a female character. Most CAs were rule-based (n=34, 72%). Experimental interventions included 63 BCTs, (mean: 9 BCTs, range 2-21)
Tudor Car L, Kyaw BM, Teo A, et 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
Dhinagaran DA, Martinengo L, Ho M-HR, et al., 2022, Designing, developing, evaluating, and Implementing a Smartphone-delivered, rule-based COnVERsational agent (DISCOVER): a conceptual framework (Preprint)
<sec> <title>BACKGROUND</title> <p>Conversational agents (CAs), also known as chatbots are computer programs that simulate human conversations using predetermined rule-based responses or employing artificial intelligent algorithms. They are increasingly used in healthcare, particularly via smartphones. There is, at present no conceptual framework guiding the development of smartphone rule-based CAs in healthcare. To fill this gap we propose structured and tailored guidance for their design, development, evaluation, and implementation.</p> </sec> <sec> <title>OBJECTIVE</title> <p>To develop a conceptual framework for the design, evaluation, and implementation of smartphone-delivered, rule-based, goal-oriented, and text-based CAs for healthcare.</p> </sec> <sec> <title>METHODS</title> <p>We followed Jabareen’s approach to develop this conceptual framework. We performed two literature reviews focusing on healthcare CAs and conceptual frameworks for the development of mHealth 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.</p> </sec> <sec> <title>RESULTS</title> <p>The DISCOVER conceptual framework includes eight iterative steps, grouped into three stages: (1) Design, comprising defining the goal, creating an identity, assembling the team, and selecting the delivery interface, (2) Development, including developing the content an
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
Martinengo L, Stona A-C, Car LT, et 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
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Cousin E, Duncan BB, Stein C, et 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% (−
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