Does Google Fit provide valid energy expenditure measurements of functional tasks compared to those of Fibion accelerometer in healthy individuals? A cross-sectional study.

BACKGROUND AND AIMS: Smartphone applications (e.g., Google Fit) may be a good alternative tool for accelerometers in estimating energy expenditure of physical activities because they are affordable, easy to use, and freely downloadable on smartphones. We aimed to determine the concurrent validity of the Fibion and Google Fit for measuring energy expenditure of functional tasks in healthy individuals. METHODS: In this cross-sectional study, 28 healthy individuals (21.25 ± 1.84 years) performed certain tasks (lying, standing, 6-min walk test, treadmill walking, stair climbing and cycling) for ∼90 min, while wearing a Fibion accelerometer on their thigh and having the Google Fit application in a smartphone placed in their trouser pocket. Concurrent validity between the energy expenditure data of the Google Fit and Fibion was assessed using the Spearman rho correlation coefficient (data were not normally distributed), Bland-Altman plots and linear regression. RESULTS: Neither energy expenditure for the whole duration nor for the tasks, except sitting + treadmill walking (r = 0.419, p = 0.027), showed significant correlations between the Google Fit and Fibion measurements. A proportional bias was evident for almost all comparisons. CONCLUSIONS: The Google Fit did not provide valid energy expenditure measurements compared to the Fibion for most of the investigated tasks in healthy individuals.

The SmartSleep Experiment: Evaluation of changes in night-time smartphone behavior following a mass media citizen science campaign.

The increasing 24-hour smartphone use is of public health concern. This study aims to evaluate whether a massive public focus on sleep and smartphone use generated through a large-scale citizen science project, the SmartSleep Experiment, influence participants' night-time smartphone behavior. A total of 8,894 Danish adults aged 16 and above participated in the SmartSleep Experiment, a web-based survey on smartphones and sleep behavior. The survey was carried out for one week in 2018, combined with an extensive national mass media campaign focusing on smartphone behaviors and sleep. A follow-up survey aimed at evaluating whether survey-participants had changed their night-time smartphone behavior was carried out two weeks after the campaign. A total of 15% of the participants who used their smartphone during sleep hours at baseline had changed their night-time smartphone behavior, and 83% of those indicated that they used their smartphone less at follow-up. The participants who had changed their smartphone behavior had primarily taken active precautions to avoid night-time smartphone use, e.g., activating silent mode (36%) or reduced their smartphone use before (50%) and during sleep hours (52%). The reduction in sleep problems (54%), recognition of poor smartphone behavior (48%), and the increased focus on night-time smartphone use (42%) were motivational factors for these behavior changes. Using citizen science and mass media appeared to be associated with changes in night-time smartphone behavior. Public health projects may benefit from combining citizen science with other interventional approaches.

Association of Smartphone Ownership and Internet Use With Markers of Health Literacy and Access: Cross-sectional Survey Study of Perspectives From Project PLACE (Population Level Approaches to Cancer Elimination).

BACKGROUND: Telehealth is an increasingly important component of health care delivery in response to the COVID-19 pandemic. However, well-documented disparities persist in the use of digital technologies. OBJECTIVE: This study aims to describe smartphone and internet use within a diverse sample, to assess the association of smartphone and internet use with markers of health literacy and health access, and to identify the mediating factors in these relationships. METHODS: Surveys were distributed to a targeted sample designed to oversample historically underserved communities from April 2017 to December 2017. Multivariate logistic regression was used to estimate the association of internet and smartphone use with outcomes describing health care access and markers of health literacy for the total cohort and after stratifying by personal history of cancer. Health care access was captured using multiple variables, including the ability to obtain medical care when needed. Markers of health literacy included self-reported confidence in obtaining health information. RESULTS: Of the 2149 participants, 1319 (61.38%) were women, 655 (30.48%) were non-Hispanic White, and 666 (30.99%) were non-Hispanic Black. The median age was 51 years (IQR 38-65). Most respondents reported using the internet (1921/2149, 89.39%) and owning a smartphone (1800/2149, 83.76%). Compared with the respondents with smartphone or internet access, those without smartphone or internet access were more likely to report that a doctor was their most recent source of health information (344/1800, 19.11% vs 116/349, 33.2% for smartphone and 380/1921, 19.78% vs 80/228, 35.1% for internet, respectively; both P<.001). Internet use was associated with having looked for information on health topics from any source (odds ratio [OR] 3.81, 95% CI 2.53-5.75) and confidence in obtaining health information when needed (OR 1.83, 95% CI 1.00-3.34) compared with noninternet users. Smartphone owners had lower odds of being unable to obtain needed medical care (OR 0.62, 95% CI 0.40-0.95) than nonsmartphone owners. Among participants with a prior history of cancer, smartphone ownership was significantly associated with higher odds of confidence in ability to obtain needed health information (OR 5.63, 95% CI 1.05-30.23) and lower odds of inability to obtain needed medical care (OR 0.17, 95% CI 0.06-0.47), although these associations were not significant among participants without a prior history of cancer. CONCLUSIONS: We describe widespread use of digital technologies in a community-based cohort, although disparities persist. In this cohort, smartphone ownership was significantly associated with ability to obtain needed medical care, suggesting that the use of smartphone technology may play a role in increasing health care access. Similarly, major illnesses such as cancer have the potential to amplify health engagement. Finally, special emphasis must be placed on reaching patient populations with limited digital access, so these patients are not further disadvantaged in the new age of telehealth.

Deep Neural Networks for Image-Based Dietary Assessment.

Due to the issues and costs associated with manual dietary assessment approaches, automated solutions are required to ease and speed up the work and increase its quality. Today, automated solutions are able to record a person's dietary intake in a much simpler way, such as by taking an image with a smartphone camera. In this article, we will focus on such image-based approaches to dietary assessment. For the food image recognition problem, deep neural networks have achieved the state of the art in recent years, and we present our work in this field. In particular, we first describe the method for food and beverage image recognition using a deep neural network architecture, called NutriNet. This method, like most research done in the early days of deep learning-based food image recognition, is limited to one output per image, and therefore unsuitable for images with multiple food or beverage items. That is why approaches that perform food image segmentation are considerably more robust, as they are able to identify any number of food or beverage items in the image. We therefore also present two methods for food image segmentation - one is based on fully convolutional networks (FCNs), and the other on deep residual networks (ResNet).

The Mobile Health Readiness of People Receiving In-Center Hemodialysis and Home Dialysis.

BACKGROUND AND OBJECTIVES: Mobile health is the health care use of mobile devices, such as smartphones. Mobile health readiness is a prerequisite to successful implementation of mobile health programs. The aim of this study was to examine the status and correlates of mobile health readiness among individuals on dialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A cross-sectional 30-item questionnaire guided by the Khatun mobile health readiness conceptual model was distributed to individuals on dialysis from 21 in-center hemodialysis facilities and 14 home dialysis centers. The survey assessed the availability of devices and the internet, proficiency, and interest in using mobile health. RESULTS: In total, 949 patients (632 hemodialysis and 317 home dialysis) completed the survey. Of those, 81% owned smartphones or other internet-capable devices, and 72% reported using the internet. The majority (70%) reported intermediate or advanced mobile health proficiency. The main reasons for using mobile health were appointments (56%), communication with health care personnel (56%), and laboratory results (55%). The main reported concerns with mobile health were privacy and security (18%). Mobile health proficiency was lower in older patients: compared with the 45- to 60-years group, respondents in age groups <45, 61-70, and >70 years had adjusted odds ratios of 5.04 (95% confidence interval, 2.23 to 11.38), 0.39 (95% confidence interval, 0.24 to 0.62), and 0.22 (95% confidence interval, 0.14 to 0.35), respectively. Proficiency was lower in participants with Hispanic/Latinx ethnicity (adjusted odds ratio, 0.49; 95% confidence interval, 0.31 to 0.75) and with less than college education (adjusted odds ratio for "below high school," 0.09; 95% confidence interval, 0.05 to 0.16 and adjusted odds ratio for "high school only," 0.26; 95% confidence interval, 0.18 to 0.39). Employment was associated with higher proficiency (adjusted odds ratio, 2.26; 95% confidence interval, 1.18 to 4.32). Although home dialysis was associated with higher proficiency in the unadjusted analyses, we did not observe this association after adjustment for other factors. CONCLUSIONS: The majority of patients on dialysis surveyed were ready for, and proficient in, mobile health. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER DIALYSIS MHEALTH SURVEY,: NCT04177277.

Factors associated with smartphone addiction: A comparative study between Japanese and Thai high school students.

BACKGROUND: Smartphone addiction is a growing social problem with adverse health outcomes. There are few comparative studies in Asia that examine factors associated with smartphone addiction. The current study aimed to address this research gap by presenting a comparative analysis of factors associated with smartphone addiction in Japan and Thailand, two countries heterogeneous in both their level of economic development and culture. METHODS: Participant data were collected using two population-based surveys. Participants were high school students in grade 11, aged 16-17 years old, and were selected using quota sampling in Japan in 2014 and random sampling in Thailand in 2016. The outcome of interest was smartphone addiction, measured using a modified version of the Young Diagnostic Questionnaire for Internet Addiction. Multiple logistic regression analysis was performed to determine factors associated with smartphone addiction (gender; nationality; family connectedness; and average time spent on smartphone per day). RESULTS: This study included a total of 7694 students, 6585 students from Japan and 1109 students from Thailand. The prevalence of smartphone addiction was 35.9% among Thai students and 12% among Japanese students. Thai students were more likely to have smartphone addiction than Japanese students (AOR 2.76; 95% CI: 2.37-3.30). Being female was associated with increased odds of smartphone addiction in both Japanese (AOR 1.53; 95% CI: 1.32-1.78) and Thai students (AOR 1.34; 95% CI: 1.01-1.78). The parental connectedness variables "my parents noticed when I was unhappy" (AOR 0.77; 95% CI: 0.62-0.96) and "my parents noticed when I did something good" (AOR 0.78, 95% CI: 0.61-0.99) were associated with lower odds of smartphone addiction among Japanese students. CONCLUSION: Smartphone addiction was more prevalent among Thai adolescents than Japanese adolescents, and more prevalent among females than males in both countries. Interventions for reducing smartphone addiction should take into account both context and gender, and should leverage the protective effect of parental connectedness.

Short-term effect of a smartphone application on the mental health of university students: A pilot study using a user-centered design self-monitoring application for mental health.

BACKGROUND: Despite the widespread recognition of the importance of mental health in young people, only a small proportion of young people with a mental disorder, including university students, receive mental health care. OBJECTIVE: We developed a smartphone application (Mental App) for the university students and examined the effects of the app on their mental health. METHODS: The app was designed according to a questionnaire survey conducted before this study. The Mental App was installed on the students' smartphone and the psychological tests (the Link Stigma Scale, the Center for Epidemiologic Studies Depression Scale, and the 12-item General Health Questionnaire) were performed on the same day. After using the App for two weeks, the students completed a questionnaire survey and underwent the same psychological tests. We compared the results between the app user and non-user group. RESULTS: A total of 68 students participated, of which 57 students completed the study (app user group, n = 28; control group, n = 29). The mean number of days spent using the app was 5.66 ± 3.16 (mean ± SD). The mean total screen time of the app was 9:03 ± 06:41(min:sec). The mean number of total actions (screen taps or swipes) was 161.91 ± 107.34. There were no significant between-group differences in the ΔLink Stigma Scale score (-0.11 ± 4.28 vs. -0.59 ± 3.30, p = 0.496) or the ΔCenter for Epidemiologic Studies Depression Scale score (-4.39 ± 7.13 vs. -2.07 ± 8.78, p = 0.143). There was a significant between-group difference in the ΔGeneral Health Questionnaire score (-2.21± 2.23 vs. -0.17 ± 2.69, p = 0.007). CONCLUSIONS: This non-randomized controlled pilot study indicates that the app we developed, may provide effective mental health care for university students, even in the short-term. Trial registration: UMIN000040332.

Business Closures, Stay-at-Home Restrictions, and COVID-19 Testing Outcomes in New York City.

INTRODUCTION: In response to the coronavirus disease 2019 (COVID-19) pandemic, New York City closed all nonessential businesses and restricted the out-of-home activities of residents as of March 22, 2020. This order affected different neighborhoods differently, as stores and workplaces are not randomly distributed across the city, and different populations may have responded differently to the out-of-home restrictions. This study examines how the business closures and activity restrictions affected COVID-19 testing results. An evaluation of whether such actions slowed the spread of the pandemic is a crucial step in designing effective public health policies. METHODS: Daily data on the fraction of COVID-19 tests yielding a positive result at the zip code level were analyzed in relation to the number of visits to local businesses (based on smartphone location) and the number of smartphones that stayed fixed at their home location. The regression model also included vectors of fixed effects for the day of the week, the calendar date, and the zip code of residence. RESULTS: A large number of visits to local businesses increased the positivity rate of COVID-19 tests, while a large number of smartphones that stayed at home decreased it. A doubling in the relative number of visits increases the positivity rate by about 12.4 percentage points (95% CI, 5.3 to 19.6). A doubling in the relative number of stay-at-home devices lowered it by 2.0 percentage points (95% CI, -2.9 to -1.2). The business closures and out-of-home activity restrictions decreased the positivity rate, accounting for approximately 25% of the decline observed in April and May 2020. CONCLUSION: Policy measures decreased the likelihood of positive results in COVID-19 tests. These specific policy tools may be successfully used when comparable health crises arise in the future.

Rationing social contact during the COVID-19 pandemic: Transmission risk and social benefits of US locations.

To prevent the spread of coronavirus disease 2019 (COVID-19), some types of public spaces have been shut down while others remain open. These decisions constitute a judgment about the relative danger and benefits of those locations. Using mobility data from a large sample of smartphones, nationally representative consumer preference surveys, and economic statistics, we measure the relative transmission reduction benefit and social cost of closing 26 categories of US locations. Our categories include types of shops, entertainments, and service providers. We rank categories by their trade-off of social benefits and transmission risk via dominance across 13 dimensions of risk and importance and through composite indexes. We find that, from February to March 2020, there were larger declines in visits to locations that our measures indicate should be closed first.

COVID-19 and applications of smartphone technology in the current pandemic.

BACKGROUND: With restrictions on face to face clinical consultations in the COVID-19 pandemic and the challenges faced by health care systems in delivering patient care, alternative information technologies like telemedicine and smartphone are playing a key role. AIMS: We assess the role and applications of smartphone technology as an extension of telemedicine in provide continuity of care to our patients and surveillance during the current COVID-19 pandemic. METHODS: We have done a comprehensive review of the literature using suitable keywords on the search engines of PubMed, SCOPUS, Google Scholar and Research Gate in the first week of May 2020. RESULTS: Through the published literature on this topic, we discuss role, common applications and its support in extended role of telemedicine technology in several aspects of current COVID-19 pandemic. CONCLUSION: Smartphone technology on its own and as extension of telemedicine has significant applications in the current COVID-19 pandemic. As the smartphone technology further evolves with fifth generation cellular network expansion, it is going to play a key role in future of health medicine, patient referral, consultation, ergonomics and many other extended applications of health care.

Measuring the Switch Cost of Smartphone Use While Walking.

This paper presents a study protocol to measure the task-switching cost of using a smartphone while walking. This method involves having participants walk on a treadmill under two experimental conditions: a control condition (i.e., simply walking) and a multitasking condition (i.e., texting while walking). During these conditions, the participants must switch between the tasks related to the experimental condition and a direction determining task. This direction task is done with a point-light walker figure, seemingly walking towards the left or the right of the participant. Performance on the direction task represents the participant's task-switching costs. There were two performance measures: 1) correct identification of the direction and 2) response time. EEG data are recorded in order to measure the alpha oscillations and cognitive engagement occurring during the task switch. This method is limited in its ecological validity: pedestrian environments have many stimuli occurring simultaneously and competing for attention. Nonetheless, this method is appropriate for pinpointing task-switching costs. The EEG data allow the study of the underlying mechanisms in the brain that are related to differing task-switching costs. This design allows the comparison between task switching when doing one task at a time, as compared to task switching when multitasking, prior to the stimulus presentation. This allows understanding and pinpointing both the behavioral and neurophysiological impact of these two different task-switching conditions. Furthermore, by correlating the task-switching costs with the brain activity, we can learn more about what causes these behavioral effects. This protocol is an appropriate base for studying the switching cost of different smartphone uses. Different tasks, questionnaires, and other measures can be added to it in order to understand the different factors involved in the task-switching cost of smartphone use while walking.

Mobile Electrocardiogram Monitoring and Health-Related Quality of Life in Patients With Atrial Fibrillation: Findings From the iPhone Helping Evaluate Atrial Fibrillation Rhythm Through Technology (iHEART) Study.

BACKGROUND: Atrial fibrillation (AF) is associated with high recurrence rates and poor health-related quality of life (HRQOL) but few effective interventions to improve HRQOL exist. OBJECTIVE: The aim of this study was to examine the impact of the "iPhone Helping Evaluate Atrial Fibrillation Rhythm through Technology" (iHEART) intervention on HRQOL in patients with AF. METHODS: We randomized English- and Spanish-speaking adult patients with AF to receive either the iHEART intervention or usual care for 6 months. The iHEART intervention used smartphone-based electrocardiogram monitoring and motivational text messages. Three instruments were used to measure HRQOL: the Atrial Fibrillation Effect on Quality of Life (AFEQT), the 36-item Short-Form Health survey, and the EuroQol-5D. We used linear mixed models to compare the effect of the iHEART intervention on HRQOL, quality-adjusted life-years, and AF symptom severity. RESULTS: A total of 238 participants were randomized to the iHEART intervention (n = 115) or usual care (n = 123). Of the participants, 77% were men and 76% were white. More than half (55%) had an AF recurrence. Both arms had improved scores from baseline to follow-up for AFEQT and AF symptom severity scores. The global AFEQT score improved 18.5 and 11.2 points in the intervention and control arms, respectively (P < .05). There were no statistically significant differences in HRQOL, quality-adjusted life-years, or AF symptom severity between groups. CONCLUSIONS: We found clinically meaningful improvements in AF-specific HRQOL and AF symptom severity for both groups. Additional research with longer follow-up should examine the influence of smartphone-based interventions for AF management on HRQOL and address the unique needs of patients diagnosed with different subtypes of AF.

A Structured E-Investigation Into the Prevalence and Acceptance of Smartphone Applications by Exercise Professionals.

Bromilow, L, Stanton, R, and Humphries, B. A structured e-investigation into the prevalence and acceptance of smartphone applications by exercise professionals. J Strength Cond Res 34(5): 1330-1339, 2020-The primary purpose of this study was to examine the prevalence and acceptance of smartphone applications by exercise professionals when interacting with clients and patients. A 29-item anonymous online survey was designed, containing separate sections on demographics, smartphone proficiency, benefits and barriers to using smartphones, and use of smartphones in a professional setting. Accredited members of the Australian Strength and Conditioning Association, and Exercise and Sports Science Australia received an information sheet through organizational communication channels, inviting them to participate. Two hundred forty-nine exercise professionals completed the survey, with men (71%; n = 176) accounting for most of the respondents. Proficiency using smartphone applications is predominantly-advanced (37%; n = 92), intermediate (33%; n = 82), or expert (14%; n = 35). Identified strategies to find smartphone applications included personal searches (67%; n = 167) and colleague recommendations (55%; n = 137). Reported benefits include fast access to information (67%; n = 167), saves time for record keeping (56%; n = 141), and allows performance tracking (55%; n = 138). Almost all respondents (92%; n = 229) identified barriers, such as inexperience with using particular applications (42%; n = 105). Almost all respondents (96%; n = 239) reported they would recommend smartphone applications to clients and patients, primarily for self-tracking (53%; n = 132). Smartphone use among exercise professionals is prevalent; however, application and sensor technology are reluctantly underused. Increasing acceptance requires embedding within educational curricula, recognition from professional organizations, and collaboration with, to maximize the potential capabilities of smartphone technology within working environments.

Evidence-based medicine self-assessment, knowledge, and integration into daily practice: a survey among Romanian physicians and comparison between trainees and specialists.

BACKGROUND: A gap between the attitude towards evidence-based medicine (EBM), knowledge and awareness has been reported among physicians from different parts of the world. However, no investigation on Romanian physicians is available in the scientific literature. Our study aimed, firstly, to assess EBM awareness and the knowledge used by Romanian physicians, and, secondly, to compare resident trainees with specialists. METHODS: Romanian trainee and specialist physicians were invited to participate in this cross-sectional study. The study tool was an online questionnaire designed to explore their awareness, knowledge, usefulness, the attitude in medical documentation, and the use of professional EBM resources. Data were collected by Google Form from January 1st to April 30th, 2017, respecting the responders' anonymity. Two groups of physicians were investigated as trainees and specialists, respectively. Descriptive statistics (number, percentage, median and interquartile range) was used to describe the survey-related variables. Statistical significance on qualitative data was calculated with the Chi-square test, Fisher's exact test, or the Z-test for proportions. RESULTS: Two hundred and 50 physicians participated in this study (68% trainees vs. 32% specialists). In both groups, a significantly high percentage was represented by women as compared to men (trainees 72.4%, specialists 70%). The correct definition of EBM was identified by most respondents (75.6%). Affirmatively, both trainees and specialists always looked at levels of evidence when reading scientific literature, but a small percentage (6.5% trainees and 3% specialists) adequately identified the uppermost types of evidence in the hierarchy. Almost a quarter of the respondents shared the name of mobile EBM resources that they used to support the daily practice. Only six out of the 49 listed mobile resources met the EBM criteria. CONCLUSIONS: The participants proved to have limited knowledge of EBM and a positive attitude towards the concept. They made use of mobile medical resources without understanding which of these were evidence-based.

Symptom Profile and Technology Use of Persons Living With HIV Who Access Services at a Community-Based Organization in the Deep South.

Currently, the Southern United States has the highest rates of new HIV diagnoses with the largest percentage of people living with HIV (PLWH), and the most Americans dying from the disease. Given the increase of the HIV epidemic in the Deep South and the availability of evidence-based self-management tools for PLWH, we conducted an in-person survey in Birmingham, Alabama, to understand the symptom profile and the use of technology by PLWH. Muscle aches or joint pain was the most frequently (67%) reported symptom followed by fatigue, sleep difficulties, neuropathy, and depressive symptoms. We also assessed mobile technology use and ownership and found that 83.7% of persons own a smartphone, with most of these (79.9%) being Android users. Given these findings, there is strong scientific premise to support the feasibility of a mobile-delivered symptom self-management tool in the Deep South for improving health outcomes for PLWH.

Technology and social media use by adult patients with intellectual and/or developmental disabilities.

BACKGROUND: Technology and social media offer individuals with intellectual and/or developmental disabilities (I/DD) unique and innovative ways to facilitate active participation in their own healthcare process. What remains unclear is the extent to which devices are currently used by this growing patient population. OBJECTIVE: To explore the prevalence of technology and social media use, as well as the possible barriers, among adult patients with I/DD. METHODS: A cross-sectional study utilizing an anonymous, accessible survey was used to obtain data from all adult patients (18 + years of age) with I/DD presenting for primary care services at a healthcare facility in New York between September and December of 2016. RESULTS: A total of 370 individuals completed the survey (529 approached, 69.9% response rate). Less than half (44.6%) of respondents used devices such as a tablet, smartphone or desktop; most (86.8%) did not use social media. Only 21.6% of respondents indicated that they use some type of assistive technology. While some respondents (46.0%) were identified by their caregivers as having a disability that would prevent them from learning/using technology, other respondents reported having no challenges (18.0%), needing training and/or ongoing support (7.4%), or being uncertain as to whether they would experience any challenges (15.5%). CONCLUSIONS: Many adult patients with I/DD do not use technology and social media that could promote self-determination and participation in their healthcare. Continued efforts must be made to promote technology use among adults with I/DD and to ensure that appropriate training is available for both the individual and his/her caregivers to achieve adoption and utilization.

Smartphone applications available to pregnant women in the United Kingdom: An assessment of nutritional information.

The importance of diet during pregnancy is critically important for the short- and long-term health of both mother and child. The number of apps targeting pregnant women is rapidly increasing, yet the nutritional content of these tools remains largely unexplored. This review aimed to evaluate the coverage and content of nutrition information in smartphone apps available to U.K. pregnant women. Keyword searches were conducted in iTunes and Google Play stores in November 2018. Candidate apps were included if they targeted pregnant women, provided pregnancy-specific nutritional information, had a user rating of at least 4+ based on at least 20 ratings, and were available in English. Nutritional content was assessed for accuracy against U.K. recommendations. Behaviour change techniques (BCTs) were also evaluated. Twenty-nine apps were included, seven of which originated in the United Kingdom. There was a large variability in the quality of smartphone app nutritional information. The accuracy of nutrition information varied, and several apps conveyed inappropriate information for pregnancy. On average, 10 BCTs were identified per app (range 2-15). Overall, smartphone apps do not consistently provide accurate and useful nutritional information to pregnant women. This study highlights the need for the integration of evidence-based nutritional information during app development and for increased regulatory oversight. App developers should also make it clear that nutritional content is intended for a specific geographical region or population or modify for the intended audience. These are important considerations for the design of future apps, which are increasingly used to complement existing maternity services.

Prevalence of problematic smartphone usage and associated mental health outcomes amongst children and young people: a systematic review, meta-analysis and GRADE of the evidence.

BACKGROUND: Over the past decade, smartphone use has become widespread amongst today's children and young people (CYP) which parallels increases in poor mental health in this group. Simultaneously, media concern abounds about the existence of 'smartphone addiction' or problematic smartphone use. There has been much recent research concerning the prevalence of problematic smartphone use is in children and young people who use smartphones, and how this syndrome relates to mental health outcomes, but this has not been synthesized and critically evaluated. AIMS: To conduct a systematic review and meta-analysis to examine the prevalence of PSU and quantify the association with mental health harms. METHODS: A search strategy using Medical Subject Headings was developed and adapted for eight databases between January 1, 1st 2011 to October 15th 2017. No language restriction was applied. Of 924 studies identified, 41 were included in this review, three of which were cohort studies and 38 were cross sectional studies. The mental health outcomes were self-reported: depression; anxiety; stress; poor sleep quality; and decreased educational attainment, which were synthesized according to an a priori protocol. RESULTS: The studies included 41,871 CYP, and 55% were female. The median prevalence of PSU amongst CYP was 23.3% (14.0-31.2%). PSU was associated with an increased odds of depression (OR = 3.17;95%CI 2.30-4.37;I2 = 78%); increased anxiety (OR = 3.05 95%CI 2.64-3.53;I2 = 0%); higher perceived stress (OR = 1.86;95%CI 1.24-2.77;I2 = 65%); and poorer sleep quality (OR = 2.60; 95%CI; 1.39-4.85, I2 = 78%). CONCLUSIONS: PSU was reported in approximately one in every four CYP and accompanied by an increased odds of poorer mental health. PSU is an evolving public health concern that requires greater study to determine the boundary between helpful and harmful technology use. Policy guidance is needed to outline harm reduction strategies.

An Assessment of Pharmacy Students' Psychological Attachment to Smartphones at Two Colleges of Pharmacy.

Objective. To determine the prevalence of nomophobia, the discomfort or anxiety experienced from being without a cellphone, among student pharmacists. Methods. A validated nomophobia questionnaire (NMP-Q) was administered to two groups of student pharmacists at two different Doctor of Pharmacy programs (N=192). Demographic and other information was collected including identified gender, year of birth, type of smartphone, and use of messaging services. Scores on the NMP-Q were used to classify respondents as absent of nomophobia (<20), having mild nomophobia (21-59), having moderate nomophobia (60-99), or having severe nomophobia (>100 out of a maximum score of 140). Results. Of 224 eligible students, 192 (85.7%) responded to the survey. Mean nomophobia scores were statistically similar between programs. Most students' scores were within the moderate nomophobia range (56.8%), while 24.5% were in the mild range and 18.2% were in the severe range. Score classifications were similar between schools. Overall, the data showed good internal consistency, with a Cronbach's alpha of .95 for the combined group. Conclusion. Nomophobia is a relatively new psychological phenomenon, and little is known about its potential implications. The student pharmacists in our study all had NMP-Q scores consistent with some degree of nomophobia. Educators must continue to study smartphone use and help student pharmacists maximize the benefits of smartphones while avoiding the potential negative psychological consequences associated with their use.