Artificial Intelligence in Medicine: Text Mining of Health Care Workers' Opinions.

BACKGROUND: Artificial intelligence (AI) is being increasingly adopted in the health care industry for administrative tasks, patient care operations, and medical research. OBJECTIVE: We aimed to examine health care workers' opinions about the adoption and implementation of AI-powered technology in the health care industry. METHODS: Data were comments about AI posted on a web-based forum by 905 health care professionals from at least 77 countries, from May 2013 to October 2021. Structural topic modeling was used to identify the topics of discussion, and hierarchical clustering was performed to determine how these topics cluster into different groups. RESULTS: Overall, 12 topics were identified from the collected comments. These comments clustered into 2 groups: impact of AI on health care system and practice and AI as a tool for disease screening, diagnosis, and treatment. Topics associated with negative sentiments included concerns about AI replacing human workers, impact of AI on traditional medical diagnostic procedures (ie, patient history and physical examination), accuracy of the algorithm, and entry of IT companies into the health care industry. Concerns about the legal liability for using AI in treating patients were also discussed. Positive topics about AI included the opportunity offered by the technology for improving the accuracy of image-based diagnosis and for enhancing personalized medicine. CONCLUSIONS: The adoption and implementation of AI applications in the health care industry are eliciting both enthusiasm and concerns about patient care quality and the future of health care professions. The successful implementation of AI-powered technologies requires the involvement of all stakeholders, including patients, health care organization workers, health insurance companies, and government regulatory agencies.

Inconclusive Findings in Studies of the Link Between Media Coverage of Mass Trauma and Depression in Children.

PURPOSE OF REVIEW: This paper reports a review of the empirical research examining the association between mass trauma media contact and depression in children, the factors that may influence the association, and the difficulties encountered in the study of media effects on depression. RECENT FINDINGS: All of the included studies assessed general population samples. Pre-COVID-19 research focused primarily on television coverage alone or on multiple media forms including television, while COVID-19 media studies examined various media forms including social media. Most studies used cross-sectional design and non-probability sampling. The review revealed inconclusive findings across studies. The study of mass trauma media effects on depression in children is complicated by a number of potential confounding factors and by the relatively high prevalence of depression in the general population. Media contact was a relatively minor consideration among other interests in the extant studies which failed to explore numerous issues that warrant attention in future research.

Telehealth Before and During the COVID-19 Pandemic: Analysis of Health Care Workers' Opinions.

BACKGROUND: The COVID-19 pandemic and the lockdowns for controlling the spread of infection have led to a surge in telehealth adoption by many health care organizations. It is unclear how this pandemic has impacted health professionals' view about telehealth. The analysis of textual data, such as comments posted on a discussion forum, can uncover information that may not be captured by a structured survey. OBJECTIVE: This study aims to examine the opinions of health care workers about telehealth services during the time frame of March 2013-December 2020. METHODS: Comments about telehealth posted by health care workers from at least 46 countries were collected from an online discussion forum dedicated to health professionals. The analysis included the computation of sentiment scores from the textual data and the use of structural topic modeling to identify the topics of discussions as well as the factors that may be associated with the prevalence of these topics. RESULTS: The analysis of the comments revealed positive opinions about the perceived benefits of telehealth services before and during the pandemic, especially the ability to reach patients who cannot come to the health facility for diverse reasons. However, opinions about these benefits were less positive during the pandemic compared to the prepandemic period. Specific issues raised during the pandemic included technical difficulties encountered during telehealth sessions and the inability to perform certain care routines through telehealth platforms. Although comments on the quality of care provided through telehealth were associated with a negative sentiment score overall, the average score was less negative during the pandemic compared to the prepandemic period, signaling a shift in opinion about the quality of telehealth services. In addition, the analysis uncovered obstacles to the adoption of telehealth, including the absence of adequate legal dispositions for telehealth services and issues regarding the payment of these services by health insurance organizations. CONCLUSIONS: Enhancing the adoption of telehealth services beyond the pandemic requires addressing issues related to the quality of care, payment of services, and legal dispositions for delivering these services.

A Critical Review of Effective Child Mass Trauma Interventions: What We Know and Do Not Know from the Evidence.

Over the last 20 years, numerous interventions have been developed and evaluated for use with children exposed to mass trauma with six publications reporting meta-analyses of randomized controlled trials of child mass trauma interventions using inactive controls to examine intervention effects on posttraumatic stress, depression, anxiety, and functional impairment. The current report reviews the results of these meta-analytic studies to examine the status of the evidence for child mass trauma mental health interventions and to evaluate potential moderators of intervention effect and implications for practice. The meta-analyses reviewed for the current report revealed a small to medium overall effect of interventions on posttraumatic stress, a non-statistically significant to small overall effect on depression, a non-statistically significant overall effect on anxiety, and a small overall effect on functional impairment. The subgroup analyses suggest that interventions should be matched to the populations being served and to the context. Additional research is needed to tailor future interventions to further address outcomes other than posttraumatic stress including depression, anxiety, and functional impairment.

The Effect of Interventions on Functional Impairment in Youth Exposed to Mass Trauma: a Meta-Analysis.

This study examined the benefit of psychosocial interventions on functional impairment in youth exposed to mass trauma. A random effects meta-analysis was used to estimate the overall effect in 15 intervention trials identified through a literature review. The moderator analysis examined how the effect of intervention differed across types of populations receiving the intervention (targeted or non-targeted samples), characteristics of intervention delivery (individual or group application and number of sessions), and the context of intervention administration (country income level). The results revealed a significant small effect on functional impairment (Hedges' g = 0.33; 95%CI = (0.16; 0.50); p = 0.0011). None of the moderators explained the heterogeneity in intervention effect, perhaps due to the small number of trials. The effect of the interventions on functional impairment and on posttraumatic stress were positively correlated. The current analysis provides preliminary evidence that interventions can improve functioning in youth exposed to mass trauma, but the mechanisms, moderators, and duration of benefit are yet unknown.

Children's Reactions to Media Coverage of War.

PURPOSE OF REVIEW: This paper reviews research on the effects of contact with war media coverage on psychological outcomes in children. RECENT FINDINGS: Children's contact with media coverage of war is pervasive and is associated with numerous outcomes and with their parents' reactions. Younger children are more affected by news stories with visual cues, while older children are more distressed by stories about actual threat. There is a strong theoretical basis for developmental influences on children's war media reactions, but the potential influence of other child factors (e.g., gender, socioeconomic disadvantage, prior trauma, culture, religious and political ideology) and aspects of coverage and the context of contact warrant additional attention. More research also is needed to explore differential effects of media coverage on children with different war exposures, the strategies children use to cope with coverage, and the mediating effects of parental involvement and intervention.

The Benefit of Interventions to Reduce Posttraumatic Stress in Youth Exposed to Mass Trauma: A Review and Meta-Analysis.

Numerous interventions to address posttraumatic stress (PTS) in youth exposed to mass trauma have been delivered and evaluated. It remains unclear, however, which interventions work for whom and under what conditions. This report describes a meta-analysis of the effect of youth mass-trauma interventions on PTS to determine if interventions were superior to inactive controls and describes a moderator analysis to examine whether the type of event, population characteristics, or income level of the country where the intervention was delivered may have affected the observed effect sizes. A comprehensive literature search identified randomized controlled trials (RCTs) of youth mass-trauma interventions relative to inactive controls. The search identified 2,232 references, of which 25 RCTs examining 27 trials (N = 4,662 participants) were included in this meta-analysis. Intervention effects were computed as Hedge's g estimates and combined using a random effects model. Moderator analyses were conducted to explain the observed heterogeneity among effect sizes using the following independent variables: disaster type (political violence versus natural disaster); sample type (targeted versus non-targeted); and income level of the country where the intervention was delivered (high- versus middle- versus low-income). The correlation between the estimates of the intervention effects on PTS and on functional impairment was estimated. The overall treatment effect size was converted into a number needed to treat (NNT) for a practical interpretation. The overall intervention effect was statistically significant (g = 0.57; P < .0001), indicating that interventions had a medium beneficial effect on PTS. None of the hypothesized moderators explained the heterogeneity among the intervention effects. Estimates of the intervention effects on PTS and on functional impairment were positively correlated (Spearman's r = 0.90; P < .0001), indicating a concomitant improvement in both outcomes. These findings confirm that interventions can alleviate PTS and enhance functioning in children exposed to mass trauma. This study extends prior research by demonstrating improvement in PTS with interventions delivered to targeted and non-targeted populations, regardless of the country income level. Intervention populations and available resources should be considered when interpreting the results of intervention studies to inform recommendations for practice.

Terrorism Media Effects in Youth Exposed to Chronic Threat and Conflict in Israel.

PURPOSE OF REVIEW: This paper reviews the extant research on the effects of contact with terrorism media coverage on psychological outcomes in youth in the context of chronic threat and conflict in Israel. RECENT FINDINGS: The extant research is inconclusive with respect to the relationship between media contact and a variety of psychological outcomes in Israeli studies of youth exposed to ongoing threat and repeated terrorist attacks. Additional research is needed to examine potential differences in outcomes and the factors that influence youth coping and adaptation in an environment of chronic threat and extensive media coverage. Moreover, studies are needed to identify and evaluate potential parental, professional, and social strategies to enhance youth adjustment. Because political conflict in Israel is not likely to abate in the near future, the setting is ideal to conduct methodologically rigorous research including research using representative samples, prospective reporting, and longitudinal design.

Is Viewing Mass Trauma Television Coverage Associated With Trauma Reactions in Adults and Youth? A Meta-Analytic Review.

This study presents the findings of meta-analyses examining the association between viewing mass trauma television coverage and posttraumatic stress (PTS) outcomes as well as acute stress reactions (ASR) among adults and youth. A literature search identified 43 (N = 31,162) studies assessing the association between viewing mass trauma television coverage and PTS and four (N = 9,083) assessing the association with ASR. The overall size of the association between viewing television coverage and PTS, estimated using a random-effect model, was small but statistically significant, r = .17, 95% CI [.13, .22]. The moderator analysis examined eight preselected variables: man-made versus natural trauma, specific incident versus chronic stressor, adult versus youth sample, proximal versus distal event exposure, television only versus combined media form, specific content in coverage versus no specific content, quantification of media contact using numeric measurement versus subjective measurement versus a binary item, and posttraumatic stress symptoms (PTSS) versus posttraumatic stress disorder (PTSD) outcome. The analysis revealed a statistically significant moderation effect for the quantification of media contact (numeric vs. subjective vs. binary) only, which accounted for 19% of the observed heterogeneity. With a summary estimate of r = .26, 95% CI [.06, .44], the analysis of the ASR studies corroborated the PTS findings. The results suggest that clinicians and public health practitioners should discuss mass trauma television viewing with their patients and with the public. Limitations of the extant research are discussed.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Relación entre la visualización de la cobertura televisiva de un trauma masivo con estrés postraumático y reacciones de estrés agudo en adultos y jóvenes: una revisión meta-analítica VISUALIZACION TELEVISIVA DE TRAUMA MASIVO Y TEPT Este estudio presenta los hallazgos de los metanálisis que examinan la asociación entre la visualización de la cobertura televisiva de trauma masivo y los resultados del estrés postraumático (EPT), así como las reacciones de estrés agudo (REA) entre adultos y jóvenes. Una búsqueda en la literatura identificó 43 (N = 31,162) estudios que evaluaron la asociación entre la visualización de la cobertura televisiva de traumas masivos y el EPT y cuatro (N = 9,083) que evaluaron la asociación con la REA. El tamaño total de la asociación entre ver la cobertura de televisión y el EPT, estimado mediante un modelo de efectos aleatorios, fue pequeño, pero estadísticamente significativo, r = .17, IC del 95% [.13, .22]. El análisis moderador examinó ocho variables preseleccionadas: trauma creado por el hombre versus trauma natural, incidente específico versus estresor crónico, muestra de adulto versus joven, exposición a eventos proximales frente a distales, televisión o formas de medios combinados, contenido específico en la cobertura versus contenido no específico, cuantificación del contacto con los medios utilizando medidas numéricas versus medidas subjetivas versus ítem binario, y síntomas de estrés postraumático (SEPT) versus resultado del trastorno de estrés postraumático (TEPT). El análisis reveló un efecto de moderación estadísticamente significativo para la cuantificación del contacto con los medios (numérico frente a subjetivo frente a binario), lo que representó el 19% de la heterogeneidad observada. Con una estimación resumida de r = .26, IC del 95% [.06, .44], el análisis de los estudios de REA corroboró los hallazgos de EPT. Los resultados sugieren que los médicos y los profesionales de la salud pública deben hablar sobre la visualización televisiva de traumas masivos con sus pacientes y con el público. Se discuten las limitaciones de la investigación existente.

Media Effects in Youth Exposed to Terrorist Incidents: a Historical Perspective.

PURPOSE OF REVIEW: This paper reviews the evidence on the relationship between contact with media coverage of terrorist incidents and psychological outcomes in children and adolescents while tracing the evolution in research methodology. RECENT FINDINGS: Studies of recent events in the USA have moved from correlational cross-sectional studies examining primarily television coverage and posttraumatic stress reactions to longitudinal studies that address multiple media forms and a range of psychological outcomes including depression and anxiety. Studies of events in the USA-the 1995 Oklahoma City bombing, the September 11 attacks, and the 2013 Boston Marathon bombing-and elsewhere have used increasingly sophisticated research methods to document a relationship between contact with various media forms and adverse psychological outcomes in children with different event exposures. Although adverse outcomes are associated with reports of greater contact with terrorism coverage in cross-sectional studies, there is insufficient evidence at this time to assume a causal relationship. Additional research is needed to investigate a host of issues such as newer media forms, high-risk populations, and contextual factors.

Do Direct Survivors of Terrorism Remaining in the Disaster Community Show Better Long-Term Outcome than Survivors Who Relocate?

Little is known about whether, compared to terrorism survivors who relocated to another area, better long-term outcome occurs in terrorism survivors who remain in the community, which may offer social support and formal services as well as ongoing trauma reminders and adversities. A cross-sectional telephone survey of OKC bombing survivors 19 years later assessed current symptoms of PTSD, anxiety and depression; posttraumatic growth; life satisfaction; medical conditions; alcohol use and smoking. We interviewed 138 survivors-114 (82.6%) remaining in OKC area and 24 (17.4%) relocated. Remaining survivors had higher PTS, anxiety and depression and lower posttraumatic growth scores than relocated survivors, and more remaining survivors disagreed with being satisfied with life, with differences not statistically significant. Groups did not differ in major medical problems except heart disease, not significantly different after adjusting for gender. Groups did not differ significantly in smoking or alcohol use. Contrary to expectations, remaining within the community after terrorism was not associated with better long-term psychological or medical outcome. Possible factors relevant to the literature are discussed.

Possible link of Interleukin-6 and Interleukin-2 with psychiatric diagnosis, ethnicity, disaster or BMI.

BACKGROUND: Cytokines are of increasing interest as markers for stress responses, mental disorders and general health. We assessed associations of two cytokines with several factors among relocated hurricane survivors and controls. METHODS: We examined 40 relocated hurricane survivors and 40 demographically matched (frequency matching) Oklahoma controls to assess relationships of Interleukin-2 (IL-2) and Interleukin-6 (IL-6) with psychiatric diagnoses (SCID-IV), demographic variables, hurricane exposure and body mass index (BMI). Participants were predominantly African American (n=70, 87.5%). RESULTS: Relocated Katrina survivors had higher proportions of current PTSD, major depression and psychiatric diagnoses than controls. Unexpectedly, exposure to Katrina with relocation was not by itself associated with differences in IL-2 or IL-6 levels. The mean IL-2 level was significantly higher in African American participants than other ethnicities (8 Caucasians, 2 Asians) and in those with a current psychiatric disorder. The mean IL-6 level was higher in females than males and in participants with any current psychiatric diagnosis. IL-6 level also correlated positively with participants' BMI. CONCLUSIONS: Results suggest that cytokines studied were influenced non-specifically by the presence of a mental disorder, and by demographic variables of gender, ethnicity and BMI. Implications of these findings are discussed, as well as possible long-term impact of the identified interleukin differences on immunologic, inflammatory, neuropsychiatric and other systems.

Randomized controlled trial of the Resilience and Coping Intervention (RCI) with undergraduate university students.

OBJECTIVE: The purpose of this pilot study was to evaluate the Resilience and Coping Intervention (RCI) with college students. PARTICIPANTS: College students (aged 18-23) from a large Midwest US university who volunteered for a randomized controlled trial during the 2015 spring semester. METHODS: College students were randomly assigned to an intervention (n = 64) or a control (n = 65) group. Intervention participants received three 45-minute RCI sessions over subsequent weeks. All participants completed pre- and post-intervention assessments at the beginning of Week 1 and end of Week 3. Student resilience, coping, hope, stress, depression, and anxiety were assessed. RESULTS: RCI participants reported significantly more hope and less stress and depression from Week 1 to Week 3 compared with control participants. Results for resilience also approached statistical significance. Effect sizes were small to moderate. CONCLUSIONS: This study found preliminary evidence that RCI is an effective resilience intervention for use with college students.

Review of Coping in Children Exposed to Mass Trauma: Measurement Tools, Coping Styles, and Clinical Implications.

Evidence-based practice requires the use of data grounded in theory with clear conceptualization and reliable and valid measurement. Unfortunately, developing a knowledge base regarding children's coping in the context of disasters, terrorism, and war has been hampered by a lack of theoretical consensus and a virtual absence of rigorous test construction, implementation, and evaluation. This report presents a comprehensive review of measurement tools assessing child and adolescent coping in the aftermath of mass trauma, with a particular emphasis on coping dimensions identified through factor analytic procedures. Coping measurement and issues related to the assessment of coping are reviewed. Concepts important in instrument development and psychometric features of coping measures used in disasters, terrorism, and war are presented. The relationships between coping dimensions and both youth characteristics and clinical outcomes also are presented. A discussion of the reviewed findings highlights the difficulty clinicians may experience when trying to integrate the inconsistencies in coping dimensions across studies. Incorporating the need for multiple informants and the difference between general and context-specific coping measures suggests the importance of a multilevel, theoretical conceptualization of coping and thus, the use of more advanced statistical measures. Attention also is given to issues deemed important for further exploration in child disaster coping research.

Intensely Exposed Oklahoma City Terrorism Survivors: Long-term Mental Health and Health Needs and Posttraumatic Growth.

In this study, we explore directly exposed terrorism survivors' mental health and health status, healthcare utilization, alcohol and tobacco use, and posttraumatic growth 18½ years postdisaster. Telephone surveys compared terrorism survivors and nonexposed community control subjects, using Hopkins Symptom Checklist, Breslau's PTSD screen, Posttraumatic Growth Inventory, and Health Status Questionnaire 12. Statistical analyses included multivariable logistic regression and linear modeling. Survivors, more than 80% injured, reported more anxiety and depression symptoms than did control subjects, with survivors' anxiety and depression associated with heavy drinking (≥5 drinks) and worse mental health and social functioning. While survivors had continued posttraumatic stress disorder symptoms (32 [23.2%] met probable posttraumatic stress disorder threshold), they also reported posttraumatic growth. Survivors had more care from physical, speech, respiratory, and occupational therapists. In this unprecedented long-term assessment, survivors' psychiatric symptoms, alcohol use, and ancillary health service utilization suggest unmet mental health and health needs. Extended recovery efforts might benefit from maximizing positive growth and coping.

Reactions of Oklahoma City bombing survivors to media coverage of the September 11, 2001, attacks.

OBJECTIVE: This study explored the effects of media coverage of a terrorist incident in individuals remote from the location of a major attack who had directly experienced a prior terrorist incident. METHOD: Directly-exposed survivors of the 1995 Oklahoma City bombing, initially studied six months after the incident, and indirectly-affected Oklahoma City community residents were assessed two to seven months after the September 11, 2001, attacks. Survivors were assessed for a diagnosis of bombing-related posttraumatic stress disorder (PTSD) at index and follow up, and emotional reactions and September 11 media behavior were assessed in all participants. RESULTS: Among the three investigated forms of media (television, radio, and newspaper), only television viewing was associated with 9/11-related posttraumatic stress reactions. Exposure to the Oklahoma City bombing was associated with greater arousal in relation to the September 11 attacks, and among survivors, having developed bombing-related PTSD was associated with higher scores on all three September 11 posttraumatic stress response clusters (intrusion, avoidance, and arousal). Although time spent watching television coverage of the September 11 attacks and fear-related discontinuation of media contact were not associated with Oklahoma City bombing exposure, discontinuing September 11 media contact due to fear was associated with avoidance/numbing in the full sample and in the analysis restricted to the bombing survivors. CONCLUSION: Surviving a prior terrorist incident and developing PTSD in relation to that incident may predispose individuals to adverse reactions to media coverage of a future terrorist attack.

Child debriefing: a review of the evidence base.

INTRODUCTION: Debriefing, a controversial crisis intervention delivered in the early aftermath of a disaster, has not been well evaluated for use with children and adolescents. This report constitutes a review of the child debriefing evidence base. METHODS: A systematic search of selected bibliographic databases (EBM Reviews, EMBASE, ERIC, Medline, Ovid, PILOTS, PubMed, and PsycINFO) was conducted in the spring of 2014 using search terms related to psychological debriefing. The search was limited to English language sources and studies of youth, aged 0 to 18 years. No time limit was placed on date of publication. The search yielded 713 references. Titles and abstracts were reviewed to select publications describing scientific studies and clinical reports. Reference sections of these publications, and of other literature known to the authors that was not generated by the search, were used to locate additional materials. Review of these materials generated 187 publications for more thorough examination; this assessment yielded a total of 91 references on debriefing in children and adolescents. Only 15 publications on debriefing in children and adolescents described empirical studies. Due to a lack of statistical analysis of effectiveness data with youth, and some articles describing the same study, only seven empirical studies described in nine papers were identified for analysis for this review. These studies were evaluated using criteria for assessment of methodological rigor in debriefing studies. RESULTS: Children and adolescents included in the seven empirical debriefing studies were survivors of motor-vehicle accidents, a maritime disaster, hostage taking, war, or peer suicides. The nine papers describing the seven studies were characterized by inconsistency in describing the interventions and populations and by a lack of information on intervention fidelity. Few of the studies used randomized design or blinded assessment. The results described in the reviewed studies were mixed in regard to debriefing's effect on posttraumatic stress, depression, anxiety, and other outcomes. Even in studies in which debriefing appeared promising, the research was compromised by potentially confounding interventions. CONCLUSION: The results highlight the small empirical evidence base for drawing conclusions about the use of debriefing with children and adolescents, and they call for further dialogue regarding challenges in evaluating debriefing and other crisis interventions in children.

Child disaster mental health interventions: therapy components.

Children face innumerable challenges following exposure to disasters. To address trauma sequelae, researchers and clinicians have developed a variety of mental health interventions. While the overall effectiveness of multiple interventions has been examined, few studies have focused on the individual components of these interventions. As a preliminary step to advancing intervention development and research, this literature review identifies and describes nine common components that comprise child disaster mental health interventions. This review concluded that future research should clearly define the constituent components included in available interventions. This will require that future studies dismantle interventions to examine the effectiveness of specific components and identify common therapeutic elements. Issues related to populations studied (eg, disaster exposure, demographic and cultural influences) and to intervention delivery (eg, timing and optimal sequencing of components) also warrant attention.

Disaster media coverage and psychological outcomes: descriptive findings in the extant research.

This review of the literature on disaster media coverage describes the events, samples, and forms of media coverage (television, newspapers, radio, internet) studied and examines the association between media consumption and psychological outcomes. A total of 36 studies representing both man-made and natural events met criteria for review in this analysis. Most studies examined disaster television viewing in the context of terrorism and explored a range of outcomes including posttraumatic stress disorder (PTSD) caseness and posttraumatic stress (PTS), depression, anxiety, stress reactions, and substance use. There is good evidence establishing a relationship between disaster television viewing and various psychological outcomes, especially PTSD caseness and PTS, but studies are too few to draw definitive conclusions about the other forms of media coverage that have been examined. As media technology continues to advance, future research is needed to investigate these additional media forms especially newer forms such as social media.

Universal preventive interventions for children in the context of disasters and terrorism.

This review addresses universal disaster and terrorism services and preventive interventions delivered to children before and after an event. The article describes the organization and structure of services used to meet the needs of children in the general population (practice applications), examines screening and intervention approaches (tools for practice), and suggests future directions for the field. A literature search identified 17 empirical studies that were analyzed to examine the timing and setting of intervention delivery, providers, conditions addressed and outcomes, and intervention approaches and components.