[Decentralized Health Promotion in Nuremberg according to the Prevention Bill: Assessment of results and experiences of the project "Health for Everyone in the District"]. / Dezentrale Gesundheitsförderung nach dem Präventionsgesetz in Nürnberg: Evaluationsergebnisse und Erfahrungen aus dem Projekt "Gesundheit für alle im Stadtteil".

BACKGROUND: The project "Health for Everyone in the District" was implemented in Nuremberg from May 2017 to October 2022 as part of the law passed to strengthen health promotion and disease prevention with funding from Public Health Insurance, Bavaria. The aim was to implement health promotion measures through a decentralized system in four deprived parts of the city and thus promote health equity on site. Among other aspects, program loyalty, project scope, and acceptance, as well as continuity and establishment of permanent structures underwent external assessment. METHOD: As part of the evaluation, quantitative data from the paper-and-pencil feedback forms of the measures (n=580), four qualitative focus group interviews with participants of the project (n=20), and an in-depth partially standardized predominantly quantitative online survey of participants and course instructors from the districts (n=67) were conducted. RESULTS: The programs were accepted by those most in need, namely women, elderly people and those with a migration background. Women, senior citizens and people with a migration background were well reached by the measures. The very high level of satisfaction with the measures showed that there were opportunities for implementation of health promotion measures into daily life taking into consideration the local environment and deprived target groups. The specifications of the guidelines for prevention, however, represented a hurdle for the long-term establishment of the measures in these districts. CONCLUSION: The project "Health for Everyone in the District " represents a local low-threshold approach to social situation-related health promotion in the municipal setting and is suitable for reaching deprived target groups with health-promoting measures. Adjustments to the guidelines for prevention could help create permanent structures on a broader scale.

[Access Paths to Health Promotion Programs for Pregnant Women and Young Families at District Level Using the Example of the HealthdistrictPlus Fürth]. / Zugangswege zu Gesundheitsförderungsmaßnahmen für Schwangere und junge Familien auf Landkreisebene am Beispiel der GesundheitsregionPlus Landkreis Fürth.

BACKGROUND: The GesundheitsregionPlus (https://www.gesundheitsregionenplus.bayern.de/) assessed measures for health promotion and primary prevention among pregnant women and young families in the area of Fuerth, Bavaria. Based on qualitative interview data, we derived a subject-orientated theoretical model of access routes to health promotion and primary prevention in the GesundheitsregionPlus area of Fuerth, Bavaria. METHODS: We interviewed seven experts and eleven pregnant women or mothers. We structured the interview data in conformity with the backward mapping method to investigate access routes to health promotion and primary prevention in the respective population. We conducted qualitative, structured content analysis to analyse the interview data. RESULTS AND CONCLUSION: The theoretical model of access routes identified three different levels of access to health promotion and primary prevention for pregnant women and young families in the GesundheitsregionPlus area of Fuerth, Bavaria. A first access route was the level of Enculturation, a second access route was the level of Motivation and a third access route was the level of Recommendation. The dominance of one of the three access routes can depend on boundary conditions such as the specific type of health promotion measure.

The Impact of Coping Styles and Gender on Situational Coping: An Ecological Momentary Assessment Study With the mHealth Application TrackYourStress.

The aim of this study was to investigate the impact of different coping styles on situational coping in everyday life situations and gender differences. An ecological momentary assessment study with the mobile health app TrackYourStress was conducted with 113 participants. The coping styles Positive Thinking, Active Stress Coping, Social Support, Support in Faith, and Alcohol and Cigarette Consumption of the Stress and Coping Inventory were measured at baseline. Situational coping was assessed by the question "How well can you cope with your momentary stress level" over 4 weeks. Multilevel models were conducted to test the effects of the coping styles on situational coping. Additionally, gender differences were evaluated. Positive Thinking (p = 0.03) and Active Stress Coping (p = 0.04) had significant positive impacts on situational coping in the total sample. For women, Social Support had a significant positive effect on situational coping (p = 0.046). For men, Active Stress Coping had a significant positive effect on situational coping (p = 0.001). Women had higher scores on the SCI scale Social Support than men (p = 0.007). These results suggest that different coping styles could be more effective in daily life for women than for men. Taking this into account, interventions tailored to users' coping styles might lead to better coping outcomes than generalized interventions.

The Neural Correlates of Analogy Component Processes.

Analogical reasoning is a core facet of higher cognition in humans. Creating analogies as we navigate the environment helps us learn. Analogies involve reframing novel encounters using knowledge of familiar, relationally similar contexts stored in memory. When an analogy links a novel encounter with a familiar context, it can aid in problem solving. Reasoning by analogy is a complex process that is mediated by multiple brain regions and mechanisms. Several advanced computational architectures have been developed to simulate how these brain processes give rise to analogical reasoning, like the "learning with inferences and schema abstraction" architecture and the Companion architecture. To obtain this power to simulate human reasoning, theses architectures assume that various computational "subprocesses" comprise analogical reasoning, such as analogical access, mapping, inference, and schema induction, consistent with the structure-mapping framework proposed decades ago. However, little is known about how these subprocesses relate to actual brain processes. While some work in neuroscience has linked analogical reasoning to regions of brain prefrontal cortex, more research is needed to investigate the wide array of specific neural hypotheses generated by the computational architectures. In the current article, we review the association between historically important computational architectures of analogy and empirical studies in neuroscience. In particular, we focus on evidence for a frontoparietal brain network underlying analogical reasoning and the degree to which brain mechanisms mirror the computational subprocesses. We also offer a general vantage on the current- and future-states of neuroscience research in this domain and provide some recommendations for future neuroimaging studies.

Corona Health-A Study- and Sensor-Based Mobile App Platform Exploring Aspects of the COVID-19 Pandemic.

Physical and mental well-being during the COVID-19 pandemic is typically assessed via surveys, which might make it difficult to conduct longitudinal studies and might lead to data suffering from recall bias. Ecological momentary assessment (EMA) driven smartphone apps can help alleviate such issues, allowing for in situ recordings. Implementing such an app is not trivial, necessitates strict regulatory and legal requirements, and requires short development cycles to appropriately react to abrupt changes in the pandemic. Based on an existing app framework, we developed Corona Health, an app that serves as a platform for deploying questionnaire-based studies in combination with recordings of mobile sensors. In this paper, we present the technical details of Corona Health and provide first insights into the collected data. Through collaborative efforts from experts from public health, medicine, psychology, and computer science, we released Corona Health publicly on Google Play and the Apple App Store (in July 2020) in eight languages and attracted 7290 installations so far. Currently, five studies related to physical and mental well-being are deployed and 17,241 questionnaires have been filled out. Corona Health proves to be a viable tool for conducting research related to the COVID-19 pandemic and can serve as a blueprint for future EMA-based studies. The data we collected will substantially improve our knowledge on mental and physical health states, traits and trajectories as well as its risk and protective factors over the course of the COVID-19 pandemic and its diverse prevention measures.

[Community-Based Nutrition Health Promotion Interventions - Evaluation of the Project "Gesunde Südstadt" in Nuremberg]. / Maßnahmen der kommunalen Gesundheitsförderung im Handlungsfeld Ernährung ­ Evaluation des Projekts "Gesunde Südstadt" der Stadt Nürnberg.

HINTERGRUND: Das Projekt "Gesunde Südstadt" hat den Schwerpunkt Gesundheitsförderung in der Lebenswelt Kommune. Es wurde im Rahmen des "Präventionsgesetzes" (SGB V §20a) initiiert und zielt ab auf die Verringerung der gesundheitlichen Ungleichheit in der Stadt Nürnberg. Die Maßnahmen der kommunalen Gesundheitsförderung im Handlungsfeld Ernährung wurden durch eine externe multiperspektivische, multimethodische Prozess- und Ergebnisevaluation begleitend untersucht. METHODEN: 55 Maßnahmenberichte, 8 Interviews mit Teilnehmenden sowie 3 Interviews mit Maßnahmendurchführenden wurden mit qualitativer Inhaltsanalyse ausgewertet. Eine Teilnehmendenbefragung (n=35) mittels Fragebögen wurde quantitativ-statistisch ausgewertet. ERGEBNISSE: Die Ergebnisse zeigen, dass die Gesundheitsförderungsmaßnahmen durch die Teilnehmenden eine hohe Akzeptanz erfuhren und ein ausgeprägtes Maß an Partizipation ermöglicht wurde. Weiterhin zeigen die Ergebnisse, dass die Maßnahmen die interaktive sowie die funktionale Gesundheitskompetenz förderten. Ein empirisches Pfadmodell für kommunale Gesundheitsförderungsprojekte wurde abgeleitet. SCHLUSSFOLGERUNG: Die Ergebnisse belegen gesundheitsförderliche Effekte eines verhältnis- und verhaltensbasierten, kommunalen Ansatzes zur Gesundheitsförderung bei Teilnehmenden an Maßnahmen im Handlungsfeld Ernährung. Das Projekt "Gesunde Südstadt" stellt einen systematischen, lebensweltrelevanten und niedrigschwelligen Ansatz der soziallagenbezogenen Gesundheitsförderung im kommunalen Setting dar. Methodische Einschränkungen, wie das Querschnittsdesign der Studie, werden diskutiert. BACKGROUND AND OBJECTIVES: The Project "Gesunde Südstadt" is focused on community-based health promotion interventions. It was initiated as part of the "Prevention Act" (SGB V §20a) and aims to reduce health inequalities in the city of Nuremberg. The community-based health promotion interventions focussing on nutrition were evaluated with an external multi-perspective, multi-method evaluation approach with a focus both on process and outcome results. METHODS: 55 reports on activities, 8 interviews with participants and 3 interviews with trainers were coded using qualitative content analysis. Statistical analyses were conducted on a participant survey (n=35). RESULTS: Results showed that the community-based health promotion interventions were not only widely accepted by the participants but also enabled them to participate in health-related activities. Additionally, health promotion interventions in the community were found to promote interactive and functional health competences. An empirically derived path model for community-based health promotion interventions was statistically tested. CONCLUSIONS: Results show health promotion effects of community-based nutrition-related health promotion interventions on participants. The project "Gesunde Südstadt" thus represents a systematic, relevant and low-threshold approach to health promotion in a communal setting. Methodological limitations such as the cross-sectional design are discussed.

A national retrospective cohort study of mechanical ventilator availability and its association with mortality risk in intensive care patients with COVID-19

ObjectivesTo determine if there is an association between survival rates in intensive care units (ICU) and occupancy of the unit on the day of admission. DesignNational retrospective observational cohort study during the COVID-19 pandemic. Setting90 English hospital trusts (i.e. groups of hospitals functioning as single operational units). Participants6,686 adults admitted to an ICU in England between 2nd April and 1st December, 2020 (inclusive), with presumed or confirmed COVID-19, for whom data was submitted to the national surveillance programme and met study inclusion criteria. InterventionsN/A Main Outcomes and MeasuresA Bayesian hierarchical approach was used to model the association between hospital trust level (mechanical ventilation compatible) bed occupancy, and in-hospital all-cause mortality. Results were adjusted for unit characteristics (pre-pandemic size), individual patient-level demographic characteristics (age, sex, ethnicity, time-to-ICU admission), and recorded chronic comorbidities (obesity, diabetes, respiratory disease, liver disease, heart disease, hypertension, immunosuppression, neurological disease, renal disease). Results121,151 patient-days were observed, with a mortality rate of 20.8 per 1,000 patient days. Adjusting for patient-level factors, mortality was higher for admissions during periods of high occupancy (>85% occupancy versus the baseline of 45 to 85%) [OR 1.18 (95% posterior credible interval (PCI): 1.00 to 1.38)]. In contrast, mortality was decreased for admissions during periods of low occupancy (<45% relative to the baseline) [OR 0.79 (95% PCI: 0.69 to 0.90)]. Conclusion and RelevanceIncreasing occupancy of beds compatible with mechanical ventilation, a proxy for operational strain, is associated with a higher mortality risk for individuals admitted to ICU. Public health interventions (such as expeditious vaccination programmes and non-pharmaceutical interventions) to control both incidence and prevalence of COVID-19, and therefore keep ICU occupancy low in the context of the pandemic, are necessary to mitigate the impact of this type of resource saturation. O_TEXTBOXSummary Box What is already known on this topicPre-pandemic, higher occupancy of intensive care units was shown to be associated with increased mortality risk. However, there is limited data on the extent to which occupancy levels impacted patient outcomes during the COVID-19 pandemic, especially in light of the mobilisation of significant additional resources. A recent study from Belgium reported a 42% higher mortality during periods of ICU surge capacity deployment, although in the analysis surge capacity was evaluated only as a binary variable, and notably this contradicts earlier results from smaller studies in Australia and Wales, where no association between ICU occupancy and mortality was identified. What this study addsThe results of this study suggest that survival rates for patients with COVID-19 in intensive care settings appears to deteriorate as the occupancy of (surge capacity) beds compatible with mechanical ventilation (a proxy for operational pressure), increases. Moreover, this risk doesnt occur above a specific threshold, but rather appears linear; whereby going from 0% occupancy to 100% occupancy increases risk of mortality by 69% (after adjusting for relevant individual-level factors). Furthermore, risk of mortality based on occupancy on the date of recorded outcome is even higher; OR 2.98 (95% posterior credible interval: 2.33 - 3.83). As such, this national-level cohort study of England provides compelling evidence for a relationship between occupancy and critical care mortality, and highlights the needs for decisive action to control the incidence and prevalence of COVID-19. C_TEXTBOX

To the lip and beyond: A case report of a midline tessier 30 Cleft

Objective@#To present the case of a midline Tessier 30 cleft in a baby boy who initially underwent a glossoplasty, cheiloplasty and mentoplasty. @*Methods@#Design: Case Report. Setting: Tertiary Government Training Hospital. Patient: One. @*Result@#A 4-month-old boy with a complete midline cleft of the lower lip, alveolus and mandible, and bifid distal tongue that was fused with the floor of the mouth, underwent glossoplasty, cheiloplasty and mentoplasty with subsequent excellent aesthetic outcome and normal oral competency. @*Conclusion@#Tessier 30 is a rare congenital midline mandibular cleft. Prompt glossoplasty, cheiloplasty and mentoplasty can correct the gross deformity, restore oral competency, and address functional needs such as feeding, swallowing and early speech development. Future bony repair will hopefully complete the reconstruction.

A Review of the History of Radioactive Iodine Theranostics: The Origin of Nuclear Ontology

Studies on the first years of radioactive iodine (RAI) use in thyroid diseases have focused on hyperthyroidism. Saul Hertz's success with RAI in thyrotoxicosis fueled a seamless transition to Samuel Seidlin's investigations with RAI in thyroid cancer. These landmark events embody nuclear ontology, a philosophical foundation for the creation and existence of radio-therapeutic principles that continue to influence clinical practices today. Laying this ontological foundation, Dr. Saul Hertz who is the founding director of Massachusetts General Hospital Thyroid Clinic, affiliated with Harvard University created a framework for RAI theranostics with preclinical experiments and clinical cases from 1937 to 1942. The first thyroid cancer treatment with RAI was applied in 1942 by Samuel Seidlin. The sensational effect of the first application was interestingly powerful enough to overshadow scientific data. Seidlin and colleagues assembled a sixteen-patient series showcasing a unique entity: functional thyroid metastases that respond to RAI. Other investigations at the time demonstrated that RAI had little efficacy as a therapeutic agent, mainly because most thyroid tumors do not form colloid, and therefore cannot concentrate RAI. These findings were soon overshadowed by a mainstream article in the October 1949 issue of Life that portrayed RAI as a lifesaving therapy for thyroid cancer. The paradigm was set, and later writings by William H. Beierwaltes and other prominent nuclear medicine physicians established the primary goals and principles of RAI therapy. The developments in theoretical physics and nuclear instrumentation and the scientists who made these developments in the early years contributed greatly to the development of the concept. In the field of nuclear medicine, William H. Beierwaltes has gone down in our history as a clinical researcher with his most important contributions. The classical paradigm that started with him has carried us to today's molecular theranoistic viewpoint. This paper examines controversial topics in the advent of thyroid theranostics, and applies historical significance to current discussions on the role of RAI in thyroid cancer management. Another paradigm shift is on the horizon as thyroidology enters the age of genomics. The molecular theranostic profiles will soon be incorporated into a dynamic clinical decision-making and management algorithm for thyroid surgery and RAI therapy. From now on, nuclear oncology will gain a new ontological identity with molecular pathology and new theranostic expansions.

Improving COVID-19 critical care mortality over time in England: A national cohort study, March to June 2020

ObjectivesTo determine the trend in mortality risk over time in people with severe COVID-19 requiring critical care (high intensive unit [HDU] or intensive care unit [ICU]) management. MethodsWe accessed national English data on all adult COVID-19 specific critical care admissions from the COVID-19 Hospitalisation in England Surveillance System (CHESS), up to the 29th June 2020 (n=14,958). The study period was 1st March until 30th May, meaning every patient had 30 days of potential follow-up available. The primary outcome was in-hospital 30-day all-cause mortality. Hazard ratios for mortality were estimated for those admitted each week using a Cox proportional hazards models, adjusting for age (non-linear restricted cubic spline), sex, ethnicity, comorbidities, and geographical region. Results30-day mortality peaked for people admitted to critical care in early April (peak 29.1% for HDU, 41.5% for ICU). There was subsequently a sustained decrease in mortality risk until the end of the study period. As a linear trend from the first week of April, adjusted mortality risk decreased by 11.2% (adjusted HR 0.89 [95% CI 0.87 - 0.91]) per week in HDU, and 9.0% (adjusted HR 0.91 [95% CI 0.88 - 0.94]) in ICU. ConclusionsThere has been a substantial mortality improvement in people admitted to critical care with COVID-19 in England, with markedly lower mortality in people admitted in mid-April and May compared to earlier in the pandemic. This trend remains after adjustment for patient demographics and comorbidities suggesting this improvement is not due to changing patient characteristics. Possible causes include the introduction of effective treatments as part of clinical trials and a falling critical care burden.

Exploring the Time Trend of Stress Levels While Using the Crowdsensing Mobile Health Platform, TrackYourStress, and the Influence of Perceived Stress Reactivity: Ecological Momentary Assessment Pilot Study.

BACKGROUND: The mobile phone app, TrackYourStress (TYS), is a new crowdsensing mobile health platform for ecological momentary assessments of perceived stress levels. OBJECTIVE: In this pilot study, we aimed to investigate the time trend of stress levels while using TYS for the entire population being studied and whether the individuals' perceived stress reactivity moderates stress level changes while using TYS. METHODS: Using TYS, stress levels were measured repeatedly with the 4-item version of the Perceived Stress Scale (PSS-4), and perceived stress reactivity was measured once with the Perceived Stress Reactivity Scale (PSRS). A total of 78 nonclinical participants, who provided 1 PSRS assessment and at least 4 repeated PSS-4 measurements, were included in this pilot study. Linear multilevel models were used to analyze the time trend of stress levels and interactions with perceived stress reactivity. RESULTS: Across the whole sample, stress levels did not change while using TYS (P=.83). Except for one subscale of the PSRS, interindividual differences in perceived stress reactivity did not influence the trajectories of stress levels. However, participants with higher scores on the PSRS subscale reactivity to failure showed a stronger increase of stress levels while using TYS than participants with lower scores (P=.04). CONCLUSIONS: TYS tracks the stress levels in daily life, and most of the results showed that stress levels do not change while using TYS. Controlled trials are necessary to evaluate whether it is specifically TYS or any other influence that worsens the stress levels of participants with higher reactivity to failure.

Using Mobile Technology to Improve Bone-Related Lifestyle Risk Factors in Young Women With Low Bone Mineral Density: Feasibility Randomized Controlled Trial.

BACKGROUND: Poor bone health in adolescent and young adult females is a growing concern. Given the widespread use of mobile phones in this population, mobile health (mHealth) interventions may help improve health behaviors related to bone health in young women. OBJECTIVE: The goal of the study was to determine the acceptability and feasibility of an mHealth intervention called Tap4Bone in improving health behaviors associated with the risk of osteoporosis in young women. METHODS: The Tap4Bone mHealth intervention comprised the use of mobile phone apps, short messaging service (text messaging), and Web emails to encourage health behavior changes. The education group received osteoporosis prevention education leaflets. Changes in the bone health-related behaviors exercise, smoking, and calcium intake were assessed. User experiences and acceptance of the app were collected through focus group interviews. RESULTS: A total of 35 (22 completed, mean age 23.1 [SD 1.8] years) were randomized to either the mobile phone (intervention n=18) or education (control n=17) group. Although there were trends toward improvement in calcium intake, sports activity, and smoking behaviors in the mHealth intervention group compared to the education group, these were not statistically significant. CONCLUSIONS: The Tap4Bone mHealth intervention was shown to be acceptable and feasible in subsets of the participants. The intervention should be improved upon using participant feedback to improve functionality. Findings from this study may aid in the development and modification of health care apps to reduce participant attrition.

A three-component model of future time perspective across adulthood.

Although extensive findings underscore the relevance of future time perspective (FTP) in the process of aging, the assumption of FTP as a unifactorial construct has been challenged. The present study explores the factorial structure of the FTP scale (Carstensen & Lang, 1996) as one of the most widely used measures (Ntotal = 2,170). Results support that FTP reflects a higher-order construct that consists of 3 interrelated components-Opportunity, Extension, and Constraint. It is suggested that the flexible usage of the FTP scale as an all compassing 10-item measure or with focus on specific components depends on the concrete research question. (PsycINFO Database Record

Comparison of Different Recruitment Methods for Sexual and Reproductive Health Research: Social Media-Based Versus Conventional Methods.

BACKGROUND: Prior research about the sexual and reproductive health of young women has relied mostly on self-reported survey studies. Thus, participant recruitment using Web-based methods can improve sexual and reproductive health research about cervical cancer prevention. In our prior study, we reported that Facebook is a promising way to reach young women for sexual and reproductive health research. However, it remains unknown whether Web-based or other conventional recruitment methods (ie, face-to-face or flyer distribution) yield comparable survey responses from similar participants. OBJECTIVE: We conducted a survey to determine whether there was a difference in the sexual and reproductive health survey responses of young Japanese women based on recruitment methods: social media-based and conventional methods. METHODS: From July 2012 to March 2013 (9 months), we invited women of ages 16-35 years in Kanagawa, Japan, to complete a Web-based questionnaire. They were recruited through either a social media-based (social networking site, SNS, group) or by conventional methods (conventional group). All participants enrolled were required to fill out and submit their responses through a Web-based questionnaire about their sexual and reproductive health for cervical cancer prevention. RESULTS: Of the 243 participants, 52.3% (127/243) were recruited by SNS, whereas 47.7% (116/243) were recruited by conventional methods. We found no differences between recruitment methods in responses to behaviors and attitudes to sexual and reproductive health survey, although more participants from the conventional group (15%, 14/95) chose not to answer the age of first intercourse compared with those from the SNS group (5.2%, 6/116; P=.03). CONCLUSIONS: No differences were found between recruitment methods in the responses of young Japanese women to a Web-based sexual and reproductive health survey.

Development and Testing of a Mobile Phone App for Self-Monitoring of Calcium Intake in Young Women.

BACKGROUND: Interventions to prevent osteoporosis by increasing dairy intake or physical activity in young women have been limited to increasing osteoporosis knowledge and awareness. However, findings have shown that this does not always lead to a change in behaviors. Self-monitoring using mobile devices in behavioral interventions has yielded significant and positive outcomes. Yet, to our knowledge, mobile self-monitoring has not been used as an intervention strategy to increase calcium intake, particularly in young women, for better bone health outcomes. OBJECTIVE: As development and testing of mobile app-based interventions requires a sequence of steps, our study focused on testing the acceptability and usability of Calci-app, a dietary app to self-monitor calcium consumption, before it is used in a behavioral change intervention in young women aged 18-25 years. METHODS: Calci-app development followed 4 steps: (1) conceptualization, (2) development and pretesting, (3) pilot testing, and (4) mixed methods evaluation. RESULTS: We present the development process of Calci-app and evaluation of the acceptability and usability of the app in young women. Overall, 78% (31/40) of study participants completed the 5-day food record with high compliance levels (defined as more than 3 days of full or partial completion). There was a significant reduction in the proportion of participants completing all meal entries over the 5 days (P=.01). Participants generally found Calci-app easy and convenient to use, but it was time-consuming and they expressed a lack of motivation to use the app. CONCLUSIONS: We present a detailed description of the development process of Calci-app and an evaluation of its usability and acceptability to self-monitor dietary calcium intake. The findings from this preliminary study demonstrated acceptable use of Calci-app to self-monitor calcium consumption. However, for regular and long-term use the self-monitoring function in Calci-app could be expanded to allow participants to view their total daily calcium intake compared with the recommended daily intake. Additionally, to facilitate sustainable lifestyle behavior modifications, a combination of various behavior change techniques should be considered, such as education, goal setting, and advice to participants based on their stage of change. The feedback on barriers and facilitators from testing Calci-app will be used to design a bone health mHealth intervention to modify risky lifestyle behaviors in young women for better bone health outcomes.

Bone Mineral Changes in Epilepsy Patients During Initial Years of Antiepileptic Drug Therapy.

Antiepileptic drug (AED) therapy is associated with decreased bone mineral density; however, the time course for this development is unclear. The aim of this study was to evaluate bone mineral changes during the initial years of AED therapy in AED-naive, newly diagnosed epilepsy patients compared with non-AED users. In 49 epilepsy patients newly started on AEDs and in 53 non-AED users of both genders, bone mineral density (BMD) and bone mineral content were measured using dual-energy X-ray absorptiometry at baseline (within the first year of therapy) and at least 1 yr later. Bone changes between the 2 assessments, adjusted for age, height, and weight, were calculated as the annual rate of change. The median duration of AED therapy was 3.5 mo at baseline and 27.6 mo at follow-up. No overall difference was found in mean BMD and bone mineral content measures between user and nonuser cohorts in both cross-sectional baseline and the annual rate of change (p > 0.05). However, users on carbamazepine monotherapy (n = 11) had an increased annual rate of total hip (-2.1% vs -0.8%, p = 0.020) and femoral neck BMD loss (-2.1% vs -0.6%, p = 0.032) compared to nonusers. They also had a marginally higher rate of femoral neck BMD loss (-2.1%, p = 0.049) compared with valproate (-0.1%, n = 13) and levetiracetam users (+0.6%, n = 13). During the initial years of AED treatment for epilepsy, no difference was found in bone measures between AED users as a group and nonuser cohorts. However, the data suggested that carbamazepine monotherapy was associated with increased bone loss at the hip regions, compared to users of levetiracetam or valproate and nonusers. Larger studies of longer duration are warranted to better delineate the bone effects of specific AEDs, with further consideration of the role of early dual-energy X-ray absorptiometry scanning and careful AED selection in potentially minimizing the impact on bone health in these patients.

Improving Vitamin D Status and Related Health in Young Women: The Safe-D study - Part B.

BACKGROUND: Vitamin D deficiency is highly prevalent and associated with increased risk of a number of chronic health conditions including cardiovascular disease, poor bone and muscle health, poor mental health, infection, and diabetes. Vitamin D deficiency affects millions of Australians, potentially causing considerable suffering, economic loss, and mortality. OBJECTIVE: To measure the effectiveness of a (1) mobile-based app (behavioral) and (2) pharmacological intervention to increase circulating 25-hydroxyvitamin D (serum 25 OHD) levels and health outcomes over 4 months of intervention compared with usual care in a cohort of young women with suboptimal serum 25 OHD levels (25-75 nmol/L). METHODS: Participants with 25 OHD levels 25 to 75 nmol/L are invited to participate in this study. Participants are randomized to one of three groups in 1:1:1 ratio: a mobile phone-based application, vitamin D supplementation (1000 IU/day), and a control group. Data collection points are at baseline, 4, and 12 months post baseline with the major endpoints being at 4 months. A wide-range of information is collected from participants throughout the course of this study. General health, behavioral and demographic information, medications, smoking, alcohol and other substance use, health risk factors, nutrition, eating patterns and disorders, and mental health data are sourced from self-administered, Web-based surveys. Clinical data include anthropometric measurements, a silicone skin cast of the hand, cutaneous melanin density, bone mineral density, and body composition scans obtained through site visits. Main analyses will be conducted in two ways on an intention-to-treat (ITT) basis using the last observation carried forward approach as an imputation for missing data, and on a per protocol basis to compare the intervention arms against the control group at 4 and 12 months. RESULTS: Publication of trial results is anticipated in 2017. CONCLUSIONS: The study will allow assessment of the effects of a mobile-based app behavioral intervention and vitamin D supplementation on vitamin D status and will evaluate the effects of improving vitamin D levels on several health outcomes.

Guidelines and Recommendations for Developing Interactive eHealth Apps for Complex Messaging in Health Promotion.

BACKGROUND: The now ubiquitous catchphrase, "There's an app for that," rings true owing to the growing number of mobile phone apps. In excess of 97,000 eHealth apps are available in major app stores. Yet the effectiveness of these apps varies greatly. While a minority of apps are developed grounded in theory and in conjunction with health care experts, the vast majority are not. This is concerning given the Hippocratic notion of "do no harm." There is currently no unified formal theory for developing interactive eHealth apps, and development is especially difficult when complex messaging is required, such as in health promotion and prevention. OBJECTIVE: This paper aims to provide insight into the creation of interactive eHealth apps for complex messaging, by leveraging the Safe-D case study, which involved complex messaging required to guide safe but sufficient UV exposure for vitamin D synthesis in users. We aim to create recommendations for developing interactive eHealth apps for complex messages based on the lessons learned during Safe-D app development. METHODS: For this case study we developed an Apple and Android app, both named Safe-D, to safely improve vitamin D status in young women through encouraging safe ultraviolet radiation exposure. The app was developed through participatory action research involving medical and human computer interaction researchers, subject matter expert clinicians, external developers, and target users. The recommendations for development were created from analysis of the development process. RESULTS: By working with clinicians and implementing disparate design examples from the literature, we developed the Safe-D app. From this development process, recommendations for developing interactive eHealth apps for complex messaging were created: (1) involve a multidisciplinary team in the development process, (2) manage complex messages to engage users, and (3) design for interactivity (tailor recommendations, remove barriers to use, design for simplicity). CONCLUSIONS: This research has provided principles for developing interactive eHealth apps for complex messaging as guidelines by aggregating existing design concepts and expanding these concepts and new learnings from our development process. A set of guidelines to develop interactive eHealth apps generally, and specifically those for complex messaging, was previously missing from the literature; this research has contributed these principles. Safe-D delivers complex messaging simply, to aid education, and explicitly, considering user safety.