Characteristics and Potential Challenges of Digital-Based Interventions for Children and Young People: Scoping Review.

BACKGROUND: Digital health technologies are becoming increasingly available to children and young people and their families. However, there are no scoping reviews that provide both an overview of the characteristics of digital interventions for children and young people and potential challenges to be considered when developing and implementing them. OBJECTIVE: This study aimed to systematically review scientific publications to identify the current characteristics and potential complications of digital interventions for children and young people. METHODS: This scoping review was conducted using the framework of Arksey and O'Malley and adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews. A search of 5 databases (PubMed, Scopus, Embase, MEDLINE, and CINAHL) and Google Scholar was performed for eligible clinical trials published between January 1, 2018, and August 19, 2022. RESULTS: The initial search of the 5 databases yielded 3775 citations; duplicates and those not meeting the inclusion criteria were eliminated. In total, 34 articles were included in the final review and relevant information, such as the descriptive characteristics and potential challenges, were classified. Mental health (26/34, 76%) was the most common target for the digital intervention for children and young people, exceeding physical health (8/34, 24%) by more than 3 times. In addition, a substantial number of digital interventions were dedicated solely to children and young people. Digital interventions for children and young people were more likely to be delivered via computers (17/34, 50%) rather than smartphones (13/34, 38%). More than one-third of the studies (13/34, 38%) applied cognitive behavioral theory as the theory of digital interventions. The duration of the digital intervention for children and young people was more likely to vary depending on the target user rather than the target disease. Intervention components were classified into 5 categories: guidance, task and activity, reminder and monitoring, supportive feedback, and reward system. Potential challenges were subcategorized into ethical, interpersonal, and societal challenges. For ethical challenges, the consent of children and young people or caregivers, potential risk of adverse events, and data privacy issues were considered. For interpersonal challenges, the engagement of children and young people was affected by the preference or barrier of caregivers to participate in studies. For societal challenges, restricted ethnicity in recruitment, limited availability of digital technology, differences in internet use patterns between girls and boys, unified clinical settings, and language barriers were described. CONCLUSIONS: We identified potential challenges and provided suggestions about ethical, interpersonal, and societal aspects to consider when developing and deploying digital-based interventions for children and young people. Our findings provide a thorough overview of the published literature and may serve as a comprehensive, informative foundation for the development and implementation of digital-based interventions for children and young people.

Echinochrome A Inhibits Melanogenesis in B16F10 Cells by Downregulating CREB Signaling.

Excessive increase in melanin pigment in the skin can be caused by a variety of environmental factors, including UV radiation, and can result in spots, freckles, and skin cancer. Therefore, it is important to develop functional whitening cosmetic reagents that regulate melanogenesis. In this study, we investigated the effects of echinochrome A (Ech A) on melanogenesis in the B16F10 murine melanoma cell line. We triggered B16F10 cells using α-MSH under Ech A treatment to observe melanin synthesis and analyze expression changes in melanogenesis-related enzymes (tyrosinase, tyrosinase-related protein 1 (TYRP1), and tyrosinase-related protein 2 (TYRP2)) at the mRNA and protein levels. Furthermore, we measured expression changes in the microphthalmia-associated transcription factor (MITF), CREB, and pCREB proteins. Melanin synthesis in the cells stimulated by α-MSH was significantly reduced by Ech A. The expression of the tyrosinase, TYRP1, and TYRP2 mRNA and proteins was significantly decreased by Ech A, as was that of the MITF, CREB, and pCREB proteins. These results show that Ech A suppresses melanin synthesis by regulating melanogenesis-related enzymes through the CREB signaling pathway and suggest the potential of Ech A as a functional agent to prevent pigmentation and promote skin whitening.

Study of the factors influencing the use of MyData platform based on personal health record data sharing system.

BACKGROUND: The application of telemedicine and electronic health (eHealth) technology has grown in importance during the COVID-19 pandemic, and a new approach in personal data management and processing MyData, has emerged. Data portability and informational self-determination are fundamental concepts of MyData. This study analysed the factors that influence acceptance of the MyData platform, which, reflects the right to self-determine personal data. METHODS: The study involved participants having experience using the MyData platform, and the key factors of the unified theory of acceptance and use of technology were used in the research model (performance expectancy, effort expectancy, social influence, facilitation condition and behavioural intention to use). The questionnaire comprided 27 items, and system usage log data were used to confirm that behavioural intention to use affected actual use behaviour through structural equation modeling. RESULTS: In total, 1153 participants completed the survey. The goodness of fit in the structural equation model indices indicates that the data fit the research model well. Performance expectancy, social influence, and facilitating conditions had direct effects on behavioural intention to use. We used system usage log data to confirm that behavioural intention to use positively affected actual use behaviour. The impact of the main factors in the unified theory of acceptance and use of technology was not moderated by age or gender, except for performance expectancy. CONCLUSIONS: This study is the first to examine the factors influencing the use of the MyData platform based on the personal health record data sharing system in Korea. In addition, the study confirmed the use behaviour of the MyData platform utilising the system's actual usage log for each function and analysing the effect of the intention of use on actual use. Our study serves as a significant foundation for the acceptance of data portability and sharing concepts. It also lays the foundation for expanding the data economy and ecosystem in the pandemic era.

Effects of Ethanol on Expression of Coding and Noncoding RNAs in Murine Neuroblastoma Neuro2a Cells.

Excessive use of alcohol can induce neurobiological and neuropathological alterations in the brain, including the hippocampus and forebrain, through changes in neurotransmitter systems, hormonal systems, and neuroimmune processes. We aimed to investigate the effects of ethanol on the expression of coding and noncoding RNAs in a brain-derived cell line exposed to ethanol. After exposing Neuro2a cells, a neuroblastoma cell line, to ethanol for 24 and 72 h, we observed cell proliferation and analyzed up- and downregulated mRNAs and long noncoding RNAs (lncRNAs) using total RNA-Seq technology. We validated the differential expression of some mRNAs and lncRNAs by RT-qPCR and analyzed the expression of Cebpd and Rnu3a through knock-down of Cebpd. Cell proliferation was significantly reduced in cells exposed to 100 mM ethanol for 72 h, with 1773 transcripts up- or downregulated by greater than three-fold in ethanol-treated cells compared to controls. Of these, 514 were identified as lncRNAs. Differentially expressed mRNAs and lncRNAs were mainly observed in cells exposed to ethanol for 72 h, in which Atm and Cnr1 decreased, but Trib3, Cebpd, and Spdef increased. On the other hand, lncRNAs Kcnq1ot1, Tug1, and Xist were changed by ethanol, and Rnu3a in particular was greatly increased by chronic ethanol treatment through inhibition of Cebpd. Our results increase the understanding of cellular and molecular mechanisms related to coding and noncoding RNAs in an in vitro model of acute and chronic exposure to ethanol.

Neurophysiological and Cognitive Correlates of Error Processing Deficits in Internet Gaming Disorder.

The ability to detect and correct errors is a critical aspect of human cognition. Neuronal dysfunction in error processing has been reported in addictive disorders. The aim of this study was to investigate neural systems underlying error processing using event-related potentials (ERPs) and current source localization as well as neurocognitive executive function tests in patients with Internet gaming disorder (IGD). A total of 68 individuals (34 patients with IGD and 34 healthy controls [HCs]) were included, and two ERP components, error-related negativity (ERN) and error positivity (Pe), were extracted during a GoNogo task. Patients with IGD exhibited significantly reduced ERN and Pe amplitudes compared with HCs. Standardized low-resolution brain electromagnetic tomography (sLORETA) in between-group comparisons revealed that patients with IGD had decreased source activations of the Pe component in the anterior cingulate cortex (ACC) under the Nogo condition. These ERP changes were associated with deficits in decision-making and response inhibition in IGD patients. The results suggest that IGD may be associated with functional abnormalities in the ACC and alterations in neural activity related to both the early unconscious and the later conscious stages of error processing, as well as deficits in area of decision-making.

Smart Healthcare Systems and Precision Medicine.

This article gives an overview of the concept and brain mechanisms of Internet game and smartphone addiction and the applicability of precision medicine and smart healthcare system. Internet game and smartphone addiction are categorized as behavioral addictions, which share similar phenomenology and neurobiological underpinnings with substance addictions. Neuroimaging studies revealed the alteration in the functional activity and structure of individuals with Internet game and smartphone addiction, which also can be potent biomarkers. Precision medicine is defined as treatments targeted to the individual patients on the basis of genetic, biomarker, phenotypic or psychosocial characteristics. Recent advances in high-throughput technology and bioinformatics have enabled us to integrate these big data with behavioral data collected from smartphones or other wearable devices. Data collected via smart devices can be transferred to medical institute and integrated in order to diagnose current status precisely and to provide optimal intervention. The feedbacks of intervention are sent back to the medical provider via self-reports or objective measures to evaluate the appropriateness of the intervention. In conclusion, Internet game and smartphone addiction can be diagnosed precisely using high-throughput technology and optimally managed via smart healthcare system.

The Impact of Internet Gaming on Alcohol Consumption.

BACKGROUND: Despite growing evidence of the adverse effects of internet gaming, it has emerged as a popular leisure activity in South Korea and Asia. This is the first study that examines the causal effect of internet gaming on alcohol consumption. AIMS OF THE STUDY: The primary goal of this study is to evaluate the effect of internet gaming on alcohol consumption while controlling for unobserved individual attributes that are omitted in the alcohol consumption regression but are correlated with internet game usage. METHODS: We use data from a survey of 5,003 men and women who lived in Seoul and the surrounding metropolitan area of South Korea during the year 2014. We use the instrumental variable regressions and partially linear regressions. RESULTS: We first find that the age at which an individual starts internet gaming and being a member of an internet gaming club are significantly associated with the average hours spent internet gaming in adulthood. Using these two instrumental variables, we show that longer hours of internet gaming is associated with less consumption of alcohol among men, but more consumption of alcohol among women. The opposite effects of internet gaming on alcohol consumption for male and female users are robust to alternative specifications and estimation methods. DISCUSSION: We investigate potential channels through which men and women are differently affected by internet gaming on alcohol consumption. We find large disparities in types of gaming devices and playing partners between men and women and that these factors account for part of the different gaming effects by gender. Other gaming preferences contributing to the heterogeneous game effects are not examined due to lack of data, which is the limitation of this study. IMPLICATIONS FOR HEALTH POLICIES: The empirical findings suggest that female users of internet games, in particular those who are vulnerable to social isolation, can reap the most benefit toward reducing the risk of developing Alcohol Use Disorder (AUD) from health interventions that aim to monitor unhealthy use of internet games. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Understanding the impact of internet gaming on other substance use such as alcohol will be useful for the design of effective clinical treatments and preventative health care provision. IMPLICATIONS FOR FURTHER RESEARCH: Based on the finding that men are likely to sit for longer periods of time indulging in games, further research may examine how the prolonged sedentary leisure activity of internet gaming affect obesity and other physical health problems.

Effects of acute and chronic methamphetamine administration on cynomolgus monkey hippocampus structure and cellular transcriptome.

Methamphetamine (MA), a psychostimulant abused worldwide, gives rise to neurotoxicity in the hippocampus, resulting in cognitive impairments and hippocampal volume reduction. The cellular and molecular mechanisms associated with hippocampal impairments due to MA remain unknown. The aim of this study was to investigate the effects of MA on structural alterations and gene expressions in the hippocampus. We analyzed the pattern of volumetric changes in the hippocampus using magnetic resonance imaging (MRI) after acute and chronic administration of MA to cynomolgus macaques. In addition, we performed large-scale transcriptome profiling in the hippocampus using RNA-Seq technology. The hippocampus in response to acute and chronic MA exhibited a significant volumetric atrophy compared with the hippocampus of controls. The genes associated with cytoskeleton organization and phagocytosis were downregulated in the acute MA-treated group compared to the control group. On the other hand, genes associated with synaptic transmission, regulation of neuron differentiation and regulation of neurogenesis were downregulated in the chronic MA-treated group. We confirmed that expression patterns for ADM, BMP4, CHRD, PDYN, UBA1, profilin 2 (PFN2), ENO2 and NSE mRNAs were similar to the results from RNA-Seq based on quantitative RT-PCR. In particular, PFN2 mRNA and protein expression levels, which play important roles in actin cytoskeleton dynamics, were decreased by acute and chronic MA administration. These results not only aid the understanding of cellular and molecular mechanisms regulated by MA in the hippocampus but also suggest basic information aiding biomarker and novel drug development for treating hippocampal impairment caused by MA abuse.

Is the Internet gaming-addicted brain close to be in a pathological state?

Internet gaming addiction (IGA) is becoming a common and widespread mental health concern. Although IGA induces a variety of negative psychosocial consequences, it is yet ambiguous whether the brain addicted to Internet gaming is considered to be in a pathological state. We investigated IGA-induced abnormalities of the brain specifically from the network perspective and qualitatively assessed whether the Internet gaming-addicted brain is in a state similar to the pathological brain. Topological properties of brain functional networks were examined by applying a graph-theoretical approach to analyzing functional magnetic resonance imaging data acquired during a resting state in 19 IGA adolescents and 20 age-matched healthy controls. We compared functional distance-based measures, global and local efficiency of resting state brain functional networks between the two groups to assess how the IGA subjects' brain was topologically altered from the controls' brain. The IGA subjects had severer impulsiveness and their brain functional networks showed higher global efficiency and lower local efficiency relative to the controls. These topological differences suggest that IGA induced brain functional networks to shift toward the random topological architecture, as exhibited in other pathological states. Furthermore, for the IGA subjects, the topological alterations were specifically attributable to interregional connections incident on the frontal region, and the degree of impulsiveness was associated with the topological alterations over the frontolimbic connections. The current findings lend support to the proposition that the Internet gaming-addicted brain could be in the state similar to pathological states in terms of topological characteristics of brain functional networks.

Comorbidity of Internet gaming disorder and alcohol use disorder: A focus on clinical characteristics and gaming patterns.

BACKGROUND AND OBJECTIVES: Although Internet gaming disorder (IGD), which has been considered as a behavioral addiction in DSM-5, shares core features with alcohol use disorder (AUD), there has been minimal research on the clinical implications of the comorbidity between IGD and AUD. The purpose of this study is to investigate clinical psychopathologies and Internet game usage patterns of IGD, AUD, and their comorbid status. METHODS: Participants (n = 1819) completed a cross-sectional web-based survey. The survey questionnaire included socio-demographic data, the IGD scale according to DSM-5 criteria, the Korean version of Alcohol Use Disorders Identification Test for AUD, the Dickman Impulsivity Inventory (DII)-short version for impulsivity, the Brief Self-Control Scale (BSCS) for self-control, the subscales of the Symptom Check-List 90 Items-Revised (SCL-90-R) for depression and anxiety, and the Behavioral Inhibition System/Behavioral Approach System Scale, and the Internet game usage patterns. RESULTS: The comorbidity group had substantially more severe clinical features such as impulsivity, impaired self-control, and mood symptoms than either IGD or AUD only. Especially the depression scale for the comorbidity group (26.0) is considerably higher than 13.0 for IGD and 16.0 for AUD alone. Furthermore, the comorbidity group spent twice as much money on Internet gaming as IGD alone (all p < .05). CONCLUSIONS AND SIGNIFICANCE: The findings of this study indicate that the comorbidity between IGD with AUD showed more severe psychopathological impairments, and the respective persons spent more money on gaming than either IGD or AUD alone. These particular characteristics may serve as feasible therapeutic targets in clinical settings. (Am J Addict 2017;26:326-334).

Treatment modalities for patients with gambling disorder.

BACKGROUND: Gambling disorder (GD) is defined as persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress. The prevalence of GD has been shown to be 1.2-7.1% in the general population. GD can severely impact on personal and vocational wellbeing as well as lead to financial problems, and has been known to be difficult to treat. This review describes the available pharmacotherapy/psychosocial treatments for GD patients, and summarizes data on the effectiveness of these GD treatments. METHODS: This review refers to newly as well as previously published studies and guidelines. RESULTS: The description of pharmacotherapy mainly focuses on opioid receptor antagonists, selective serotonin reuptake inhibitors, and mood stabilizers. Psychosocial treatments/strategies mainly include cognitive behavioral therapy, motivational interviewing, and Gamblers Anonymous. We also introduce relatively novel treatment modalities. CONCLUSIONS: This review can help clinicians to decide treatment plans for their GD patients. In addition, it can be used as a reference for designing future research.

An association study of Taq1A ANKK1 and C957T and - 141C DRD2 polymorphisms in adults with internet gaming disorder: a pilot study.

BACKGROUND: Though Internet gaming disorder (IGD) is considered to share similar genetic vulnerability with substance addictions, little has been explored about the role of the genetic variants on IGD. This pilot study was designed to investigate the association of the Taq1A polymorphism of the ankyrin repeat and kinase domain containing 1 (ANKK1) gene and C957T and - 141C of the dopamine D2 receptor (DRD2) with IGD and their role on the personality and temperament traits in IGD among adult population. METHODS: Sixty-three subjects with IGD and 87 control subjects who regularly played Internet games were recruited. Self-administered questionnaires on self-control, dysfunctional impulsivity, and temperament and character domains were done. The Taq1A ANKK1 and the C957T and - 141C ins/del from the DRD2 genes were genotyped using the specific TaqMan PCR assay. RESULTS: The distributions of allele and genotype frequencies were not significantly different between the IGD and control groups in both genders. In male, excessive gaming and use of gaming to escape from a negative feeling were associated with the del- genotype of the - 141C. Among IGD, the del+ genotype was associated with higher novelty seeking. Logistic regression showed no predictive value of these polymorphisms for IGD when using age and gender as covariates. CONCLUSIONS: Though no direct association of the Taq1A ANKK1 and C957T DRD2 variants with IGD were observed, the - 141C polymorphism may play a role in IGD via mediating symptoms or temperament traits.

Development and validation of a stock addiction inventory (SAI).

BACKGROUND: Investing in financial markets is promoted and protected by the government as an essential economic activity, but can turn into a gambling addiction problem. Until now, few scales have widely been used to identify gambling addicts in financial markets. This study aimed to develop a self-rating scale to distinguish them. In addition, the reliability and validity of the stock addiction inventory (SAI) were demonstrated. METHODS: A set of questionnaires, including the SAI, south oaks gambling screen (SOGS), and DSM-5 diagnostic criteria, for gambling disorder was completed by 1005 participants. Factor analysis, internal consistency testing, t tests, analysis of variance, and partial correlation analysis were conducted to verify the reliability and validity of SAI. RESULTS: The factor analysis results showed the final SAI consisting of two factors and nine items. The internal consistency and concurrent validity of SAI were verified. The Cronbach's α for the total scale was 0.892, and the SAI and its factors were significantly correlated with SOGS. CONCLUSIONS: This study developed a specific scale for financial market investments or trading; this scale proved to be reliable and valid. Our scale expands the understanding of gambling addiction in financial markets and provides a diagnostic reference.

Effects of Moderate Alcohol Intake in the Bladder of the Otsuka Long Evans Tokushima Fatty Diabetic Rats.

Diabetes is related with a number of cystopathic complications. However, there have been no studies about the influence of alcohol consumption in the bladder of type 2 diabetes. Thus, we investigated the effect of moderate alcohol intake in the bladder of the Otsuka Long Evans Tokushima Fatty (OLETF) diabetic rat. The non-diabetic Long-Evans Tokushima Otsuka (LETO, n=14) and the OLETF control group (n=14) were fed an isocaloric diet; the LETO (n=14) and the OLETF ethanol group (n=14) were fed 36% ethanol 7 g/kg/day. After ten weeks, muscarinic receptors, RhoGEFs, myogenic change, and the level of oxidative stress were evaluated. Moderate alcohol intake significantly decreased excessive muscarinic receptor and Rho kinase expressions in the OLETF rats compared with the LETO rats. In addition, iNOS and collagen expression were not changed in the OLETF rats in spite of alcohol consumption. Superoxide dismutase levels, which is involved in antioxidant defense, in the LETO rats were significantly decreased after alcohol consumption, however those in the OLETF rats were similar. Moderate alcohol consumption reduces the oxidative stress, and may prevent molecular and pathologic changes of the bladder of rats with type 2 diabetes.

The relationship between brain-derived neurotrophic factor and cognitive functions in alcohol-dependent patients: a preliminary study.

BACKGROUND: As a neurotoxic substance, alcohol can induce neurodegenesis in the brain. Alcohol-dependent patients' cognitive functioning can be affected by chronic alcohol use. In addition, brain-derived neurotrophic factor (BDNF) is known to reflect the status of neuroadaptive changes. The purpose of this study was to investigate the relationship between cognitive functions and BDNF in alcohol-dependent patients. METHODS: The subjects were 39 alcohol-dependent patients. BDNF was measured using an enzyme-linked immunosorbent assay kit. We examined clinical features and administered the Korean version of Alcohol Dependence Scale. We also used the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) to measure cognitive functioning. Then, we determined the relationships between BDNF and various parts of the CERAD. RESULTS: The performance of alcohol-dependent patients proved stable in most parts of the CERAD. Within the different parts of the CERAD, only Trail Making Test B correlated with BDNF. Trail Making Test specifically assesses executive functions. CONCLUSIONS: BDNF might play an important role in the detection of neurocognitive function among individuals with alcohol dependence.

Chronic Alcohol Consumption Results in Greater Damage to the Pancreas Than to the Liver in the Rats.

Alcohol consumption increases the risk of type 2 diabetes. However, its effects on prediabetes or early diabetes have not been studied. We investigated endoplasmic reticulum (ER) stress in the pancreas and liver resulting from chronic alcohol consumption in the prediabetes and early stages of diabetes. We separated Otsuka Long-Evans Tokushima Fatty (OLETF) rats, a type-2 diabetic animal model, into two groups based on diabetic stage: prediabetes and early diabetes were defined as occurrence between the ages of 11 to 16 weeks and 17 to 22 weeks, respectively. The experimental group received an ethanol-containing liquid diet for 6 weeks. An intraperitoneal glucose tolerance test was conducted after 16 and 22 weeks for the prediabetic and early diabetes groups, respectively. There were no significant differences in body weight between the control and ethanol groups. Fasting and 120-min glucose levels were lower and higher, respectively, in the ethanol group than in the control group. In prediabetes rats, alcohol induced significant expression of ER stress markers in the pancreas; however, alcohol did not affect the liver. In early diabetes rats, alcohol significantly increased most ER stress-marker levels in both the pancreas and liver. These results indicate that chronic alcohol consumption increased the risk of diabetes in prediabetic and early diabetic OLETF rats; the pancreas was more susceptible to damage than was the liver in the early diabetic stages, and the adaptive and proapoptotic pathway of ER stress may play key roles in the development and progression of diabetes affected by chronic alcohol ingestion.

Shared psychological characteristics that are linked to aggression between patients with Internet addiction and those with alcohol dependence.

BACKGROUND: Internet addiction (IA) is considered as one of behavioral addictions. Although common neurobiological mechanisms have been suggested to underlie behavioral addiction and substance dependence, few studies have directly compared IA with substance dependence, such as alcohol dependence (AD). METHODS: We compared patients with IA, AD, and healthy controls (HC) in terms of the Five Factor Model of personality and with regard to impulsiveness, anger expression, and mood to explore psychological factors that are linked to aggression. All patients were treatment-seeking and had moderate-to-severe symptoms. RESULTS: The IA and AD groups showed a lower level of agreeableness and higher levels of neuroticism, impulsivity, and anger expression compared with the HC group, which are characteristics related to aggression. The addiction groups showed lower levels of extraversion, openness to experience, and conscientiousness and were more depressive and anxious than the HCs, and the severity of IA and AD symptoms was positively correlated with these types of psychopathology. CONCLUSIONS: IA and AD are similar in terms of personality, temperament, and emotion, and they share common characteristics that may lead to aggression. Our findings suggest that strategies to reduce aggression in patients with IA are necessary and that IA and AD are closely related and should be dealt with as having a close nosological relationship.

White matter hyperintensities in mild cognitive impairment: clinical impact of location and interaction with lacunes and medial temporal atrophy.

This study was to evaluate the influence on cognition and activities of daily living (ADL) by white matter hyperintensities (WMHs) based on the severity and location, as well as the interactions among WMHs, lacunes, and medial temporal atrophy (MTA). In 150 patients with amnestic mild cognitive impairment, WMHs were quantified with the use of a semiautomated volumetric method. Lacune counting and MTA assessment were performed by visual rating. The severer WMHs were, the more executive functions decreased. The influence on executive functions such as verbal fluency test and Stroop color reading test were greater in periventricular (PV) WMHs than deep WMHs, as well as bigger in anterior, middle, and posterior areas in order. The instrumental (I) ADL was strongly associated with the anterior (P = .028) and middle area (P = .014) of PVWMHs only. WMHs had synergistic interactions with lacunes in Controlled Oral Word Association Task-semantic (ß = -1.12; R(2) = .24; P = .039), Stroop color (ß = -2.07; R(2) = .15; P = .049), and IADL (ß = .23; R(2) = .20; P = .009). Anterior PVWMHs demonstrated the most powerful impact on frontal executive dysfunction and poor performance of IADL. WMHs had synergistic effects with the number of lacunes on them. Therefore, it is desirable to consider WMHs and lacunes simultaneously as potential imaging biomarkers for predicting cognition and IADL in aMCI.

Developing a Cost-Effectiveness Model of Digital Therapeutics for Smoking Cessation.

The purpose of this research was to construct a Markov model of digital therapeutics to predict the lifetime costs and consequences that would be incurred by a hypothetical group of adult smokers in Korea who only made a single attempt to stop smoking. To determine the efficacy of DTx, we created an annual cycle Markov model. The result shows that the NRT strategy is determined as the dominant strategy. Digital therapeutics acts as a complement to pharmacotherapy and is a low-cost option.

A Review of Current Digital Mental Health Care Applications for Anxiety Symptoms and Future Prospects.

OBJECTIVE: Since the impact of the coronavirus disease-2019 pandemic, the need for efficiency in medical services has become more urgent than ever. The digital treatment market is rapidly growing worldwide and digital therapeutics (DTx), a major part of the digital medical services, is also emerging as a new paradigm for treatment, with its industry growing rapidly as well. Increasing research is done on the effectiveness of mobile DTx in improving mental health conditions such as insomnia, panic, and depression. METHODS: This review paper investigates 1) the functions and characteristics of mobile digital mental health care applications for the treatment of anxiety symptoms, 2) extracts common attributes of the applications, and 3) compares them with existing traditional treatment mechanisms. RESULTS: Among the 20,000 mental health management applications that have been developed so far, 8 applications that are relatively widely used were selected and reviewed. Check-in, self-help tips, quick relief, journal, courses for practice are common features of the digital mental health care applications for anxiety and are also widely used feature in the cognitive behavioral therapy. CONCLUSION: Based on this review, we have proposed the essential elements and directions for the development of a Korean digital mental health care applications for anxiety disorders.