The Effect of a Program to Improve Adherence to the Mediterranean Diet on Cardiometabolic Parameters in 7034 Spanish Workers.

BACKGROUND: Cardiovascular and metabolic diseases include a large group of pathologies and constitute one of the most serious chronic health problems facing the 21st century, with high rates of morbidity and mortality worldwide. Unhealthy diets influence the development of these pathologies. The Mediterranean diet can be an important part in the treatment of these diseases. The objective of this study was to assess the effect of a program that aims to increase adherence to the Mediterranean diet on the improvement of different cardiometabolic risk parameters. METHODS: A prospective intervention study was carried out on 7034 Spanish workers. Prior to the intervention, 22 cardiometabolic risk scales were evaluated. Participants in this study were informed both orally and in writing of the characteristics and benefits of the Mediterranean diet and were given the website of the Ministry of Health, Consumption and Social Welfare of Spain, which provides advice on nutrition. Adherence to the Mediterranean diet was reinforced by sending a monthly SMS to their mobile phones. After six months of follow-up, the 22 risk scales were re-evaluated to assess changes. Means and standard deviations were calculated using Student's t test to analyse quantitative variables. Prevalence was calculated using the Chi-square test when the variables were qualitative. RESULTS: All the cardiometabolic risk scales studied decreased after implementing a program to improve and enhance adherence to the Mediterranean diet. The number of losses in the sample was very low, standing at 4.31%. CONCLUSIONS: The Mediterranean diet is effective in reducing all cardiovascular risk scales evaluated. The mean values and prevalence of high values of the different cardiometabolic risk scales analysed led to lower values after the implementation of the program to increase adherence to the Mediterranean diet. We observed a significant positive difference in metabolic age in both sexes. We have obtained a significant improvement in the insulin resistance index, especially in the SPISE-IR index, data that we have not found in previous publications. Easy access to the Internet and new information and communication technologies facilitate adherence to a diet and can reduce the number of losses.

Utilisation of mobile phone interventions to improve the delivery of maternal health services in sub-Saharan Africa: A scoping review protocol.

INTRODUCTION: There has been significant progress in maternal health outcomes in the sub-Saharan African region since the early 1990s, in part due to digital and mobile health interventions. However, critical gaps and disparities remain. Mobile phones in particular have potential to reach underserved, hard-to-reach populations with underdeveloped infrastructure. In spite of the opportunities for mobile phones to address maternal mortality in the region, there is no extensive mapping of the available literature on mobile phone interventions that aim to improve access of maternal care in sub-Saharan Africa. The proposed scoping review aims to map literature on the nature and extent of mobile phones interventions designed to improve maternal care health services in the region. METHODS: Conduct of this scoping review will be guided by the Joanna Briggs Institute approach. Literature searches will be conducted in multiple electronic databases, including MEDLINE, Embase, CINAHL, APA PsycInfo, Cochrane Central Register of Controlled Trials, Global Health, African Index Medicus, Web of Science, and Applied Social Sciences Index & Abstracts. Grey literature will also be identified. Keyword searches will be used to identify articles. Two reviewers will independently screen eligible titles, abstracts and full articles with a third reviewer to help resolve any disputes. We will extract data on general study characteristics, population characteristics, concept, context, intervention details, study results, gaps and recommendations. DISCUSSION: Understanding use of mobile phones among underserved, hard-to-reach populations with underdeveloped infrastructure to address maternal mortality in developing countries is very critical to informing health systems on potential effective strategies. This review will complement the evidence base on utilisation of mobile phone interventions to improve the delivery of maternal health services in sub-Saharan Africa.

Designing a sustainable reverse logistics network for used cell phones based on offline and online trading systems.

Unsustainable production and consumption are driving a significant increase in global electronic waste, posing substantial environmental and human health risks. Even in more developed nations, there is the challenge of low collection rates. In response, we integrate offline and online trading systems and design a material efficiency strategy for used cell phones. We propose a new multi-objective optimization framework to maximize profit, carbon emissions reduction, and circularity in the process of recycling and treatment. Considering multi-period, multi-product, multi-echelon features, as well as price sensitive demand, incentives, and qualities, we established a new multi-objective mixed-integer nonlinear programming optimization model. An enhanced, Fast, Non-Dominated Solution Sorting Genetic Algorithm (ASDNSGA-II) is developed for the solution. We used operational data from a leading Chinese Internet platform to validate the proposed optimization framework. The results demonstrate that the reverse logistics network designed achieves a win-win situation regarding profit and carbon emission reduction. This significantly boosts confidence and motivation for engaging in recycling efforts. Online recycling shows robust profitability and carbon reduction capabilities. An effective coordination mechanism for pricing in both online and offline channels should be established, retaining offline methods while gradually transitioning towards online methods. To increase the collection rate, it is essential to jointly implement a transitional strategy, including recycling incentives and subsidy policies. Additionally, elevating customer environmental awareness should be viewed as a long-term strategy, mitigating the cost of increasing collection rates during the market maturity stage (high collection rates).

Follow-up non-attendance after long-bone fractures in a low-resource setting: a prospective study of predictors and interventions to increase attendance rates.

BACKGROUND: While the majority of traumatic injuries occur in low- and middle-income countries, the published literature comes chiefly from high-income countries due to poor follow-up. Clinical and radiographic post-surgical trauma follow-up is essential to high-quality research and objective monitoring for healing and/or complications. This study aimed to identify the predictors of follow-up non-attendance in a low-resource setting and investigate the extent to which interventional efforts based on mobile phone technology (MPT) and home visits improved the follow-up rates for fractures treated with SIGN nails. METHODS: This was a prospective study of 594 patients with long-bone fractures. Socio-demographic (e.g. age, gender, marital status, education level, etc.) and clinical (e.g. fracture type, concomitant injuries, comorbidity, etc.) data were collected on each patient. Before discharge, the importance of follow-up was explained to patients and their relations. They were encouraged to attend even if they felt well. Their residential addresses and telephone numbers were validated and securely stored. Patients who missed their appointments were contacted by phone. Those who failed to honour 2 or 3 rescheduled appointments were visited in their home. The patients were divided into those who returned for the primarily scheduled follow-up without prompting (volition group) and those who did not come (non-attenders). Univariate analyses and binary logistic regression were conducted to determine the significant predictors of non-attendance. RESULTS: The proportion of patients in the volition group reduced from 96.1% at 6 weeks to 53.0% at 12 weeks and 39.2% at 6 months. However, interventional efforts increased these values to 98.5%, 92.5%, and 72.4% respectively. Walking unaided before the primarily scheduled 12-week appointment was the major reason for not attending the follow-up. Education, occupation, post-operative length of hospital stay (PLOS) and infection were significantly associated with non-attendance but younger age, long distances from the hospital, being separated or divorced, difficulty paying the in-patient care bill, closed fracture, having no (or a non-limb) concomitant injury, achieving painless weight bearing ≤ 6 weeks post-operatively and needing no additional surgery were independent predictors of non-attendance. CONCLUSIONS: Our study sheds light on the predictors of follow-up non-attendance and demonstrates how interventional efforts improved attendance rates in a low-resource setting. In addition, efforts that better the socio-economic status of people such as more-encompassing health insurance coverage and greater work flexibility can improve the follow-up attendance rates.

Mobile Technology-Based Interventions for Stroke Self-Management Support: Scoping Review.

BACKGROUND: There is growing interest in enhancing stroke self-management support using mobile health (mHealth) technology (eg, smartphones and apps). Despite this growing interest, "self-management support" is inconsistently defined and applied in the poststroke mHealth intervention literature, which limits efforts to synthesize and compare evidence. To address this gap in conceptual clarity, a scoping review was conducted. OBJECTIVE: The objectives were to (1) identify and describe the types of poststroke mHealth interventions evaluated using a randomized controlled trial design, (2) determine whether (and how) such interventions align with well-accepted conceptualizations of self-management support (the theory by Lorig and Holman and the Practical Reviews in Self-Management Support [PRISMS] taxonomy by Pearce and colleagues), and (3) identify the mHealth functions that facilitate self-management. METHODS: A scoping review was conducted according to the methodology by Arksey and O'Malley and Levac et al. In total, 7 databases were searched. Article screening and data extraction were performed by 2 reviewers. The data were analyzed using descriptive statistics and content analysis. RESULTS: A total of 29 studies (26 interventions) were included. The interventions addressed 7 focal areas (physical exercise, risk factor management, linguistic exercise, activities of daily living training, medication adherence, stroke education, and weight management), 5 types of mobile devices (mobile phones or smartphones, tablets, wearable sensors, wireless monitoring devices, and laptops), and 7 mHealth functions (educating, communicating, goal setting, monitoring, providing feedback, reminding, and motivating). Collectively, the interventions aligned well with the concept of self-management support. However, on an individual basis (per intervention), the alignment was less strong. CONCLUSIONS: On the basis of the results, it is recommended that future research on poststroke mHealth interventions be more theoretically driven, more multidisciplinary, and larger in scale.

Brecha digital en cuidadores de pacientes pediátricos de 0 a 12 años. Diseño y validación de un cuestionario / The digital divide among caregivers of pediatric patients aged 0 to 12 years. Design and validation of a questionnaire

Introducción. Las estrategias sanitarias basadas en tecnologías de la información y la comunicación (TIC) podrían perpetuar la inequidad en salud, especialmente en poblaciones vulnerables. Existen escasas herramientas validadas para evaluar el acceso a las TIC en pediatría en nuestro medio. Objetivos. Construir y validar un cuestionario para evaluar el acceso a las TIC para cuidadores de pacientes pediátricos. Describir las características de acceso a las TIC y evaluar si existe correlación entre los tres niveles de la brecha digital. Población y métodos. Construimos y validamos un cuestionario que luego administramos a cuidadores de niños entre 0 y 12 años. Las variables de resultado fueron las preguntas del cuestionario para los tres niveles de brecha digital. Además, evaluamos variables sociodemográficas. Resultados. Administramos el cuestionario a 344 cuidadores. El 93 % poseía celular propio y el 98,3 % utilizaba internet por red de datos. El 99,1 % se comunicaba a través de mensajes de WhatsApp. El 28 % había realizado una teleconsulta. La correlación entre las preguntas fue nula o baja. Conclusión. Por medio del cuestionario validado, evaluamos que los cuidadores de pacientes pediátricos de 0 a 12 años poseen en su mayoría celular, se conectan por red de datos, se comunican principalmente a través de WhatsApp y obtienen pocos beneficios a través de TIC. La correlación entre los diferentes componentes del acceso a las TIC fue baja.

Introduction. Health care strategies based on information and communication technologies (ICTs) may perpetuate health inequity, especially among vulnerable populations. In our setting, there are few validated tools to assess access to ICTs in pediatrics. Objectives. To develop and validate a questionnaire to assess ICT access among caregivers of pediatric patients. To describe the characteristics of ICT access and assess whether there is a correlation among the three levels of the digital divide. Population and methods. We developed and validated a questionnaire and then administered it to the caregivers of children aged 0­12 years. The outcome variables were the questions in the three levels of the digital divide. We also assessed sociodemographic variables. Results. We administered the questionnaire to 344 caregivers. Among them, 93% had their own cell phone and 98.3% had Internet access via a data network; 99.1% communicated via WhatsApp messages; 28% had had a teleconsultation. The correlation among the questions was null or low. Conclusion. The validated questionnaire allowed us to establish that the caregivers of pediatric patients aged 0­12 years mostly own a mobile phone, access the Internet via a data network, communicate mainly through WhatsApp, and obtain few benefits through ICTs. The correlation among the different components of ICT access was low.

Digital Health Equity and Tailored Health Care Service for People With Disability: User-Centered Design and Usability Study.

BACKGROUND: As digital health services advance, digital health equity has become a significant concern. However, people with disability and older adults still face health management limitations, particularly in the COVID-19 pandemic. An essential area of investigation is proposing a patient-centered design strategy that uses patient-generated health data (PGHD) to facilitate optimal communication with caregivers and health care service providers. OBJECTIVE: This study aims to conceptualize, develop, and validate a digitally integrated health care service platform for people with disability, caregivers, and health care professionals, using Internet of Things devices and PGHD to contribute to improving digital health equity. METHODS: The methodology consists of 5 stages. First, a collaborative review of the previous app, Daily Healthcare 1.0, was conducted with individuals with disabilities, caregivers, and health care professionals. Secondly, user needs were identified via personas, scenarios, and user interface sketches to shape a user-centered service design. The third stage created an enhanced app that integrated these specifications. In the fourth stage, heuristic evaluations by clinical and app experts paved the way for Daily Healthcare 2.0, now featuring Internet of Things device integration. Conclusively, in the fifth stage, an extensive 2-month usability evaluation was executed with user groups comprising individuals with disabilities using the app and their caregivers. RESULTS: Among the participants, "disability welfare information and related institutional linkage" was the highest priority. Three of the 14 user interface sketches the participants created were related to "providing educational content." The 11 heuristic evaluation experts identified "focusing on a single task" as a crucial issue and advocated redesigning the home menu to simplify it and integrate detailed menus. Subsequently, the app Daily Healthcare 2.0 was developed, incorporating wearable devices for collecting PGHD and connecting individuals with disabilities, caregivers, and health care professionals. After the 2-month usability evaluation with 27 participants, all participants showed an increase in eHealth literacy, particularly those who used the caregiver app. Relatively older users demonstrated improved scores in health IT usability and smartphone self-efficacy. All users' satisfaction and willingness to recommend increased, although their willingness to pay decreased. CONCLUSIONS: In this study, we underscore the significance of incorporating the distinct needs of individuals with disabilities, caregivers, and health care professionals from the design phase of a digital health care service, highlighting its potential to advance digital health equity. Our findings also elucidate the potential benefits of fostering partnerships between health consumers and providers, thereby attenuating the vulnerability of marginalized groups, even amid crises such as the COVID-19 pandemic. Emphasizing this imperative, we advocate for sustained endeavors to bolster the digital literacy of individuals with disabilities and champion collaborative cocreation, aiming to uphold the collective ethos of health and digital health equity.

Determining the content and needs assessment a mobile-based self-care program in infertile men.

BACKGROUND: Infertility is a public health problem in the world, using new technology, such as mobile phones, is increasing in the field of health. This study aimed to determine the Necessity of self-care training contents by performing a needs analysis among men with infertility problems to design a mobile phone-based application. METHODS: Followed by reviewing the related literature, a questionnaire including 40 educational items and seven software features was designed in three general sections and distributed among 30 specialists in nutrition (n = 18) and infertility (n = 12). The validity of the questionnaire was confirmed by a panel of experts in nutrition, infertility, and medical informatics. The questionnaire's reliability was also corroborated by Cronbach's alpha of 86.4. RESULTS: All items related to the software features and most items in the questionnaire were deemed necessary by participants. However, the items: "Occupation and history of chronic diseases" in the demographic information section and "Effects of infertility and food allergy" in the educational section were not confirmed. CONCLUSION: The present findings could not only highlight the patients' roles in managing their disease but also increase the healthcare workers' awareness in designing the hospital information system.

Human mobility networks reveal increased segregation in large cities.

A long-standing expectation is that large, dense and cosmopolitan areas support socioeconomic mixing and exposure among diverse individuals1-6. Assessing this hypothesis has been difficult because previous measures of socioeconomic mixing have relied on static residential housing data rather than real-life exposures among people at work, in places of leisure and in home neighbourhoods7,8. Here we develop a measure of exposure segregation that captures the socioeconomic diversity of these everyday encounters. Using mobile phone mobility data to represent 1.6 billion real-world exposures among 9.6 million people in the United States, we measure exposure segregation across 382 metropolitan statistical areas (MSAs) and 2,829 counties. We find that exposure segregation is 67% higher in the ten largest MSAs than in small MSAs with fewer than 100,000 residents. This means that, contrary to expectations, residents of large cosmopolitan areas have less exposure to a socioeconomically diverse range of individuals. Second, we find that the increased socioeconomic segregation in large cities arises because they offer a greater choice of differentiated spaces targeted to specific socioeconomic groups. Third, we find that this segregation-increasing effect is countered when a city's hubs (such as shopping centres) are positioned to bridge diverse neighbourhoods and therefore attract people of all socioeconomic statuses. Our findings challenge a long-standing conjecture in human geography and highlight how urban design can both prevent and facilitate encounters among diverse individuals.

Comment on Redmayne, M.; Maisch, D.R. ICNIRP Guidelines' Exposure Assessment Method for 5G Millimetre Wave Radiation May Trigger Adverse Effects. Int. J. Environ. Res. Public Health 2023, 20, 5267.

This article discusses the contention in the commented-upon paper that Brillouin precursors generated by 5G New Radio (5G NR) and other cellular systems are a possible cause of tissue damage at deeper layers of tissue than the power penetration depth of the carrier frequency. The original theory for Brillouin precursors from pulsed radiofrequency signals (RF-EMF) and speculation about their possible health effects dates back to the 1990's and was based on studies of the propagation of very short (nanosecond) ultrawide-bandwidth RF pulses through water. This assumption is not correct for cellular telephone signals due to their narrow bandwidth. The commented-on paper provides no alternative rationale as to why Brillouin effects should cause tissue damage from RF-EMF radiation from cellular and other communications systems. Other inaccuracies in this paper concerning thermal responses of tissue to RF-EMF are also noted.

Survey the effectiveness of education based on message framing through mobile phone on women's physical activity.

BACKGROUND: Physical activity in female employees is a healthy behavior and increases strength, endurance, improves flexibility, improves the feeling of vitality and freshness, improves health, and ultimately increases life expectancy. Health messages are one of the most effective ways to engage people and motivate them to perform healthy behaviors. The purpose of this study was to the study of the effectiveness of education based on message framing through mobile phone (whatsapp) on the physical activity of women employees of universities and higher education institutions in Ahvaz city. METHOD: In this interventional study, 90 of female employees of three universities and higher education institutions of Ahvaz city were selected by random sampling and randomly divided into three groups (30 participants) receiving gain framed messages, receiving loss framed messages and the control group. The tools of data collection were demographic information questionnaire and international physical activity questionnaire (IPAQ). The participants of the intervention groups received educational messages about physical activity behavior in two different gain and loss framed messages through whatsapp for one month. Data were collected from three groups at the beginning of the study, immediately and two months after the intervention, and were analyzed using SPSS version 26. RESULTS: The results showed that there was a significant increase in the average physical activity score after the intervention in two interventional groups. by comparing the increase of this score, 53% improvement in physical activity is observed in the gain message group and 15% in loss massage group but there was no significant increase in the control group. CONCLUSION: The results of this study showed that the design and implementation of education programs based on message framing, especially gain framed messages through online education (Whatsapp) can improve and promote physical activity behavior in women employees.

Measuring under-5 mortality and fertility through mobile phone surveys: an assessment of selection bias in 34 low-income and middle-income countries.

OBJECTIVES: This study aims to assess sample selection bias in mobile phone survey estimates of fertility and under-5 mortality. DESIGN: With data from the Demographic and Health Surveys, we use logistic regressions to identify sociodemographic correlates of mobile phone ownership and access, and Poisson regressions to estimate the association between mobile phone ownership (or access) and fertility and under-5 mortality estimates. We evaluate the potential reasons why estimates by mobile phone ownership differ using a set of behavioural characteristics. SETTING: 34 low-income and middle-income countries, mostly in sub-Saharan Africa. PARTICIPANTS: 534 536 women between the ages of 15 and 49. OUTCOME MEASURES: Under-5 mortality rate (U5MR) and total fertility rate (TFR). RESULTS: Mobile phone ownership ranges from 23.6% in Burundi to 96.7% in Armenia. The median TFR ratio and U5MR ratio between the non-owners and the owners of a mobile phone are 1.48 and 1.29, respectively. Fertility and mortality rates would be biased downwards if estimates are only based on women who own or have access to mobile phones. Estimates of U5MR can be adjusted through poststratification using age, educational level, area of residence, wealth and marital status as weights. However, estimates of TFR remain biased even after adjusting for these covariates. This difference is associated with behavioural factors (eg, contraceptive use) that are not captured by the poststratification variables, but for which there are also differences between mobile phone owners and non-owners. CONCLUSIONS: Mobile phone surveys need to collect data on sociodemographic background characteristics to be able to weight and adjust mortality estimates ex post facto. Fertility estimates from mobile phone surveys will be biased unless further research uncovers the mechanisms driving the bias.

Cell phone microscopy enabled low-cost manufacturable colorimetric urine glucose test.

Glucose serves as a pivotal biomarker crucial for the monitoring and diagnosis of a spectrum of medical conditions, encompassing hypoglycemia, hyperglycemia, and diabetes, all of which may precipitate severe clinical manifestations in individuals. As a result, there is a growing demand within the medical domain for the development of rapid, cost-effective, and user-friendly diagnostic tools. In this research article, we introduce an innovative glucose sensor that relies on microfluidic devices meticulously crafted from disposable, medical-grade tapes. These devices incorporate glucose urine analysis strips securely affixed to microscope glass slides. The microfluidic channels are intricately created through laser cutting, representing a departure from traditional cleanroom techniques. This approach streamlines production processes, enhances cost-efficiency, and obviates the need for specialized equipment. Subsequent to the absorption of the target solution, the disposable device is enclosed within a 3D-printed housing. Image capture is seamlessly facilitated through the use of a smartphone camera for subsequent colorimetric analysis. Our study adeptly demonstrates the glucose sensor's capability to accurately quantify glucose concentrations within sucrose solutions. This is achieved by employing an exponential regression model, elucidating the intricate relationship between glucose concentrations and average RGB (Red-Green-Blue) values. Furthermore, our comprehensive analysis reveals minimal variation in sensor performance across different instances. Significantly, this study underscores the potential adaptability and versatility of our solution for a wide array of assay types and smartphone-based sensor systems, making it particularly promising for deployment in resource-constrained settings and undeveloped countries. The robust correlation established between glucose concentrations and average RGB values, substantiated by an impressive R-square value of 0.98709, underscores the effectiveness and reliability of our pioneering approach within the medical field.

Health care needs, eHealth literacy, use of mobile phone functionalities, and intention to use it for self-management purposes by informal caregivers of children with burns: a survey study.

BACKGROUND: This study aimed to assess health care needs, electronic health literacy, mobile phone usage, and intention to use it for self-management purposes by informal caregivers of children with burn injuries. METHODS: This cross-sectional research was carried out in 2021 with 112 informal caregivers of children with burns in a burn center in the north of Iran. The data collection tools were questionnaires that included the participants' demographics, their E-Health Literacy, their current mobile phone usage, and their desires for mobile phone use for burn care services. RESULTS: Most informal caregivers had smartphones (83.0%) and Internet access (81.3%). Most participants occasionally used phone calls (63.4%), the Internet (45.5%), and social media (42.9) to receive information about psychosocial disorders, infection control, wound care, pain, itch, physical exercise, and feeding. Most participants have never used some of the mobile phone functionalities to receive burn-related information, such as applications/Software (99.1%) and e-mail (99.1%). Nevertheless, most informal caregivers desire to use mobile applications for self-management purposes in the future (88.4%). The mean eHealth literacy score was 25.01 (SD = 9.61). Informal caregivers who had higher education levels, access to the Internet, and lived in urban areas had higher eHealth literacy (P < 001). CONCLUSION: The current research delivers beneficial information about the healthcare needs of informal caregivers and their preference to use mobile functionality to receive burns-related healthcare and rehabilitation information post-discharge. This information can help design and implement mobile health (mHealth) interventions to enhance the self-care skills of informal caregivers.

A wearable-based sports health monitoring system using CNN and LSTM with self-attentions.

Sports performance and health monitoring are essential for athletes to maintain peak performance and avoid potential injuries. In this paper, we propose a sports health monitoring system that utilizes wearable devices, cloud computing, and deep learning to monitor the health status of sports persons. The system consists of a wearable device that collects various physiological parameters and a cloud server that contains a deep learning model to predict the sportsperson's health status. The proposed model combines a Convolutional Neural Network (CNN), Long Short-Term Memory (LSTM), and self-attention mechanisms. The model is trained on a large dataset of sports persons' physiological data and achieves an accuracy of 93%, specificity of 94%, precision of 95%, and an F1 score of 92%. The sports person can access the cloud server using their mobile phone to receive a report of their health status, which can be used to monitor their performance and make any necessary adjustments to their training or competition schedule.

Validation of Photoplethysmography Using a Mobile Phone Application for the Assessment of Heart Rate Variability in the Context of Heart Rate Variability-Biofeedback.

OBJECTIVE: Heart rate variability-biofeedback (HRV-BF) is an effective intervention to reduce stress and anxiety and requires accurate measures of real-time HRV. HRV can be measured through photoplethysmography (PPG) using the camera of a mobile phone. No studies have directly compared HRV-BF supported through PPG against classical electrocardiogram (ECG). The current study aimed to validate PPG HRV measurements during HRV-BF against ECG. METHODS: Fifty-seven healthy participants (70% women) with a mean (standard deviation) age of 26.70 (9.86) years received HRV-BF in the laboratory. Participants filled out questionnaires and performed five times a 5-minute diaphragmatic breathing exercise at different paces (range, ~6.5 to ~4.5 breaths/min). Four HRV indices obtained through PPG, using the Happitech software development kit, and ECG, using the validated NeXus apparatus, were calculated and compared: RMSSD, pNN50, LFpower, and HFpower. Resonance frequency (i.e., optimal breathing pace) was also compared between methods. RESULTS: All intraclass correlation coefficient values of the five different breathing paces were "near perfect" (>0.90) for all HRV indices: lnRMSSD, lnpNN50, lnLFpower, and lnHFpower. All Bland-Altman analyses (with just three incidental exceptions) showed good interchangeability of PPG- and ECG-derived HRV indices. No systematic evidence for proportional bias was found for any of the HRV indices. In addition, correspondence in resonance frequency detection was good with 76.6% agreement between PPG and ECG. CONCLUSIONS: PPG is a potentially reliable and valid method for the assessment of HRV. PPG is a promising replacement of ECG assessment to measure resonance frequency during HRV-BF.

An Assessment of Patient Portal Messaging Use by Patients With Multiple Chronic Conditions Living in Rural Communities: Retrospective Analysis.

BACKGROUND: Patient portals can facilitate the delivery of health care services and support self-management for patients with multiple chronic conditions. Despite their benefits, the evidence of patient portal use among patients with multimorbidity in rural communities is limited. OBJECTIVE: This study aimed to explore the factors associated with portal messaging use by rural patients. METHODS: We assessed patient portal use among patients with ≥1 chronic diagnoses who sent or received messages via the Epic MyChart (Epic Systems Corporation) portal between January 1, 2015, and November 9, 2021. Patient portal use was defined as sending or receiving a message through the portal during the study period. We fit a zero-inflated negative binomial model to predict portal use based on the patient's number of chronic conditions, sex, race, age, marital status, and insurance type. County-level characteristics, based on the patient's home address, were also included in the model to assess the influence of community factors on portal use. County-level factors included educational attainment, smartphone ownership, median income, and primary care provider density. RESULTS: A total of 65,178 patients (n=38,587, 59.2% female and n=21,454, 32.92% Black) were included in the final data set, of which 38,380 (58.88%) sent at least 1 message via the portal during the 7-year study period. As the number of chronic diagnoses increased, so did portal messaging use; however, this relationship was driven primarily by younger patients. Patients with 2 chronic conditions were 1.57 times more likely to send messages via the portal than those with 1 chronic condition (P<.001). In comparison, patients with ≥7 chronic conditions were approximately 11 times more likely to send messages than patients with 1 chronic condition (P<.001). A robustness check confirmed the interaction effect of age and the number of diagnoses on portal messaging. In the model including only patients aged <65 years, there was a significant effect of increased portal messaging corresponding to the number of chronic conditions (P<.001). Conversely, this relationship was not significant for the model consisting of older patients. Other significant factors associated with increased portal use include being female; White; married; having private insurance; and living in an area with a higher average level of educational attainment, greater medical provider density, and a lower median income. CONCLUSIONS: Patients' use of the portal to send messages to providers was incrementally related to their number of diagnoses. As the number of chronic diagnoses increased, so did portal messaging use. Patients of all ages, particularly those living in rural areas, could benefit from the convenience and cost-effectiveness of portal communication. Health care systems and providers are encouraged to increase the use of patient portals by implementing educational interventions to promote the advantages of portal communication, particularly among patients with multimorbidity.

Dynamic risk assessment of urban flood disasters based on functional area division-A case study in Shenzhen, China.

The assessment of urban flood risk plays a vital role in disaster prevention and mitigation. This work aims to assess the dynamic risk of urban flood triggered by population movements through dividing urban functional zoning from the perspective of collective cognition. Firstly, the urban functional areas are identified using Points of Interest data and then the population movements mobile is detected based on functional areas using mobile signaling big data. Then, one-dimensional and two-dimensional hydrodynamic models are employed to simulate the 50-year flood scenario in Futian District, Shenzhen. Finally, a spatio-temporal dynamic assessment model for urban flood risk is constructed based on the extent of inundation, water depth, population density, and the disaster-bearing capacity of functional areas. The research findings are as follows: (1) Futian District's urban planning showcases harmonious integration of single-function and mixed-function areas. Utilizing the 50% perception standard efficiently identifies distinct functional types across diverse urban zones. The results are highly consistent with the actual situation. (2) During morning peak hours, the population exhibits a nuanced pattern of dispersal, concentration, and transition. Lunchtime witnesses multiple central clusters forming and gradually dispersing, while the evening peak witnesses population regrouping, covering broader geographical extents. Dynamic utilization of functional areas and mobile phone signaling data outperforms static population metrics, offering deeper insights into the complexities of human activity. (3) Between 12:00 and 13:00, lunchtime movements lead to a surge of 6 high-risk zones in the central area and 5 in the Meiling area. The dynamic flood risk assessment model, based on functional area delineation, effectively identifies disparities and fluctuations in flood risk across diverse functional areas during rainfall scenarios, ensuring heightened precision and accuracy in risk assessment.

Validation of low-cost mobile phone applications and comparison with professional imaging systems for three-dimensional facial imaging: A pilot study.

PURPOSE: The objective of this study was to investigate the accuracies of three-dimensional (3D) facial scanning mobile phone applications as compared to professional 3D facial imaging systems. MATERIALS AND METHODS: A manikin head model was used as the subject for comparing six 3D facial imaging systems which comprised three professional 3D scanners (3dMDface, Artec Eva and Vectra H2) and three mobile phone applications (Bellus3D, ScandyPro and Hedges). For each system, five scans were taken to analyse (1) linear accuracy using 9 measurements (2) global and (3) regional 3D accuracy of the scanned surface by root mean square (RMS) and colour map analysis. Another set of five scans was repeated by a second operator to evaluate the inter-operator reproducibility for each system. RESULTS: All the facial imaging systems had absolute errors lesser than 1.0 mm for the linear measurements. The technical error of measurement (TEM) for inter-examiner and intra-examiner linear measurements were within acceptable limits. Artec Eva, Vectra H2 and Scandy Pro had poor global 3D trueness (RMS > 1.0 mm) but good 3D regional trueness (RMS < 1.0 mm). 3dMDface, Bellus3D Face App and Heges had good global and regional 3D trueness. All the facial imaging systems had good global and regional 3D precision and reproducibility (RMS < 1.0 mm). CONCLUSION: This study demonstrated that mobile phone 3D scanning applications had comparable trueness, precision and reproducibility to professional systems. Colour map analysis supplemented the use of the RMS value to demonstrate facial regions of significant deviation. Clinicians should also consider the specific area or region of inaccuracies for each system to determine whether the chosen system is appropriate for the clinical condition or procedure. CLINICAL SIGNIFICANCE: Mobile phone 3D facial imaging applications may be as accurate as 3D professional facial scanning systems for craniomaxillofacial purposes. However, the choice of the system may vary depending on the specific area of interest.

Dosimetric assessment in the brain for downlink EMF exposure in Korean mobile communication networks.

Because the position and direction of the human body is not fixed in an actual environment, the incidence direction of the electromagnetic field (EMF) from mobile communication base stations, WiFi access points, broadcasting towers, and other far-field sources is arbitrary. To analyze the overall health effects of radio frequency EMF exposure, the dosimetric assessment for such environmental exposures created from an unspecified number of sources in daily life, along with exposures from specific EMF sources, must be quantified. This study is aimed at numerically evaluating the time-averaged specific absorption rate (SAR) of the human brain for environmental EMF exposure in the frequency range of 50-5800 MHz. Whole-body exposure to EMFs that are evenly incident spatially is considered. By comparing the results of several incidence directions and the number of polarizations, an optimal calculation condition has been derived. Finally, based on the results measured in Seoul at the end of 2021, the SAR and daily specific energy absorption (SA) in the brains of both a child and an adult for downlink exposures from 3G to 5G base stations are reported. Comparison results of the daily brain SA for exposure to DL EMF in all 3G to 5G mobile networks and exposure to a 10-min voice call (uplink EMF) using a mobile phone connected to a 4G network show that the SA from the downlinks is much higher than that from the uplinks.