A Comprehensive Review on Exploring the Impact of Telemedicine on Healthcare Accessibility.

Telemedicine has emerged as a transformative force in healthcare delivery, particularly in improving healthcare accessibility. This comprehensive review examines the impact of telemedicine on healthcare accessibility, exploring its ability to overcome geographical, financial, sociocultural, and infrastructural barriers to healthcare access. Through remote consultations, monitoring, and diagnosis facilitated by technology, telemedicine extends healthcare reach to remote and underserved areas while enhancing temporal accessibility with round-the-clock availability. By streamlining healthcare delivery systems, telemedicine reduces costs and promotes efficiency, ultimately fostering health equity and improving health outcomes. However, technological barriers, regulatory hurdles, and patient acceptance remain. To realize telemedicine's full potential, collaboration among stakeholders in the healthcare and technology sectors is imperative. Policymakers must enact supportive regulations, healthcare providers must integrate telemedicine into their practices, and technology companies must innovate to develop user-friendly platforms. Through concerted efforts, telemedicine can catalyze advancing healthcare accessibility and enhance the health and well-being of individuals worldwide.

Assessing soil erosion and farmers' decision of reducing erosion for sustainable soil and water conservation in Burji woreda, southern Ethiopia.

Inadequate conservation practice affects the sustainable production of agricultural watersheds due to erosion and fertility decline. Understanding soil erosion and implementing site-specific conservation practice could enhance agriculture-based rural development. The study was aimed to document soil erosion problem and soil and water conservation effort. The specific objectives of this study were to assess soil erosion severity, practices to reduce erosion, and determinants of the decision to reduce erosion. Data were collected by interviewing 198 farm household heads, undertaking four focus group discussions, and assessing rill erosion in 10 farm fields in Morayo and Wacho sub-watersheds of southern Ethiopia. Descriptive statistics and binary logit model were applied to analyze the data. Results indicated that many of the farm households, 63% in Morayo and 83% in the Wacho sub-watershed, perceived moderate to severe soil erosion, which is characterized by big rills and small gullies on the farmlands. Rill densities of 231.4 m ha-1 and 84.1 m ha-1 in the Morayo and Wacho sub-watersheds were observed, respectively. The estimated annual soil loss due to rills was 61.2 and 23.4 Mg ha-1 in the Morayo and Wacho sub-watersheds, respectively. The soil erosion from rills alone exceeds the expected tolerable soil erosion (11 tons ha-1 year-1). Due to erosion, about 90% of farmers perceived farmland degradation as described by a progressive decline in crop yield. Farmers used to practice traditional techniques to reduce erosion and government introduced conservation measures such as soil and stone bunds. However, many farmers did not use well-promoted conservation measures such as bunds, which could have negative impact on long-term erosion control effort and sustainable implementation of the conservation options. Among the assessed explanatory variables, educational level, farm distance from home, slope of the cultivated land, and frequency of extension contact were significantly affected (p < 0.05) farmers' sustainable use of conservation measures. Development planners and policy makers are advised to consider site-specific and innovative approaches to implement conservation measures in sustainable approach in the smallholder crop-livestock mixed agriculture system.

Uterus transplantation: what the world's religions have to say.

Uterus transplantation (UTx) has evolved from a purely experimental procedure to a clinical treatment option available outside the clinical trial context, offering women with absolute uterine-factor infertility an opportunity to experience pregnancy. As UTx becomes better established and more widely known and performed, it is likely to be sought out by geographically and culturally diverse patients, particularly those whose religious beliefs impose barriers to other paths to achieve parenthood, such as gestational surrogacy and adoption. Many religions do not currently have official positions on UTx, meaning that clinicians involved in screening candidates can expect questions about how the UTx process aligns with various religious beliefs. This article provides a broad background on the current positions major world religions have taken on UTx (or its components) and the alternative paths to parenthood of gestational surrogacy and adoption. It is intended to help clinicians communicate the information necessary for individuals interested in uterus donation or transplantation to determine-in consultation with their spiritual advisors or religious authorities when needed-how these options align with religious beliefs or teachings.

The role of champions in the implementation of technology in healthcare services: a systematic mixed studies review.

BACKGROUND: Champions play a critical role in implementing technology within healthcare services. While prior studies have explored the presence and characteristics of champions, this review delves into the experiences of healthcare personnel holding champion roles, as well as the experiences of healthcare personnel interacting with them. By synthesizing existing knowledge, this review aims to inform decisions regarding the inclusion of champions as a strategy in technology implementation and guide healthcare personnel in these roles. METHODS: A systematic mixed studies review, covering qualitative, quantitative, or mixed designs, was conducted from September 2022 to March 2023. The search spanned Medline, Embase, CINAHL, and Scopus, focusing on studies published from 2012 onwards. The review centered on health personnel serving as champions in technology implementation within healthcare services. Quality assessments utilized the Mixed Methods Appraisal Tool (MMAT). RESULTS: From 1629 screened studies, 23 were included. The champion role was often examined within the broader context of technology implementation. Limited studies explicitly explored experiences related to the champion role from both champions' and health personnel's perspectives. Champions emerged as promoters of technology, supporting its adoption. Success factors included anchoring and selection processes, champions' expertise, and effective role performance. DISCUSSION: The specific tasks and responsibilities assigned to champions differed across reviewed studies, highlighting that the role of champion is a broad one, dependent on the technology being implemented and the site implementing it. Findings indicated a correlation between champion experiences and organizational characteristics. The role's firm anchoring within the organization is crucial. Limited evidence suggests that volunteering, hiring newly graduated health personnel, and having multiple champions can facilitate technology implementation. Existing studies predominantly focused on client health records and hospitals, emphasizing the need for broader research across healthcare services. CONCLUSIONS: With a clear mandate, dedicated time, and proper training, health personnel in champion roles can significantly contribute professional, technological, and personal competencies to facilitate technology adoption within healthcare services. The review finds that the concept of champions is a broad one and finds varied definitions of the champion role concept. This underscores the importance of describing organizational characteristics, and highlights areas for future research to enhance technology implementation strategies in different healthcare settings with support of a champion.

Adopting, implementing and assimilating coproduced health and social care innovations involving structurally vulnerable populations: findings from a longitudinal, multiple case study design in Canada, Scotland and Sweden.

BACKGROUND: Innovations in coproduction are shaping public service reform in diverse contexts around the world. Although many innovations are local, others have expanded and evolved over time. We know very little, however, about the process of implementation and evolution of coproduction. The purpose of this study was to explore the adoption, implementation and assimilation of three approaches to the coproduction of public services with structurally vulnerable groups. METHODS: We conducted a 4 year longitudinal multiple case study (2019-2023) of three coproduced public service innovations involving vulnerable populations: ESTHER in Jönköping Region, Sweden involving people with multiple complex needs (Case 1); Making Recovery Real in Dundee, Scotland with people who have serious mental illness (Case 2); and Learning Centres in Manitoba, Canada (Case 3), also involving people with serious mental illness. Data sources included 14 interviews with strategic decision-makers and a document analysis to understand the history and contextual factors relating to each case. Three frameworks informed the case study protocol, semi-structured interview guides, data extraction, deductive coding and analysis: the Consolidated Framework for Implementation Research, the Diffusion of Innovation model and Lozeau's Compatibility Gaps to understand assimilation. RESULTS: The adoption of coproduction involving structurally vulnerable populations was a notable evolution of existing improvement efforts in Cases 1 and 3, while impetus by an external change agency, existing collaborative efforts among community organizations, and the opportunity to inform a new municipal mental health policy sparked adoption in Case 2. In all cases, coproduced innovation centred around a central philosophy that valued lived experience on an equal basis with professional knowledge in coproduction processes. This philosophical orientation offered flexibility and adaptability to local contexts, thereby facilitating implementation when compared with more defined programming. According to the informants, efforts to avoid co-optation risks were successful, resulting in the assimilation of new mindsets and coproduction processes, with examples of how this had led to transformative change. CONCLUSIONS: In exploring innovations in coproduction with structurally vulnerable groups, our findings suggest several additional considerations when applying existing theoretical frameworks. These include the philosophical nature of the innovation, the need to study the evolution of the innovation itself as it emerges over time, greater attention to partnered processes as disruptors to existing power structures and an emphasis on driving transformational change in organizational cultures.

A method of building information modelling implementation for structural engineering firms.

Building Information Modelling (BIM), a new concept and methodology, has received much attention lately. Various Structural Engineering Firms (SEFs) have observed substantial competitive benefits after its deployment. BIM offers a wide range of advantages, but its capacity has not even been completely exploited. The challenges of firm implementation, a procedure that necessitates significant alterations in firm business structure, are a major factor in this. However, there hasn't been much in-depth research on the assessment and integration of the research around the application of BIM in firms. To address the planning phase's complexity, which makes implementing BIM in these workplaces challenging, this article provides a framework for BIM deployment in the SEF. Additionally, a brand-new hybrid African Buffalo and African Vulture Optimization (AB-AVO) has been created to assess the state of technology. The technique suggested for BIM execution within SEF obviously and effectively recognises the firm's expectations and resources, sets out the needs required to create the BIM technique, and offers technical and clinical suggestions for monitoring and planning the execution. It is categorised by resource utilization, versatility, and adaptability.•This paper introduces a new concept and methodology of using BIM•The technique suggested for BIM execution within SEF obviously and effectively recognises the firm's expectations and resources•The method establishes guidelines for structural firm to adopt BIM in their monitoring, and planning the execution.

Enabling food system innovation: accelerators for change.

It is widely accepted that current food systems are not on a trajectory for achieving the Sustainable Development Goals by the end of the decade. Technological innovation will have a considerable role to play in different parts of the food system; many promising options exist or are in the pipeline, some of which may be highly disruptive to existing value chains. Scaling up the innovations required, at the same time as protecting those who may lose out in the short term, will require a strong enabling environment. Here we apply an existing framework of eight change accelerators to six case studies of historical agricultural innovation. We estimated the degree to which each accelerator had been addressed at some stage in the innovation process, as a measure of the gap between what was needed and what was achieved. For the innovations that are being taken to scale and widely utilized, these accelerator gaps are small. Uptake of other innovations is stalled, and for these we found large gaps for one or more of the eight accelerators. Impactful innovation processes address all eight change accelerators at some point, with different phasing of the accelerators depending on the nature of the technology and on the impact pathway being pursued. This simple framework, when used in combination with narratives of uptake based on theories of change and impact pathways, may provide an effective means of screening future innovation processes to help prioritize and guide investment that can lead to more resilient, sustainable and equitable food systems.

Effects of perceptions of forest change and intergroup competition on community-based conservation behaviors.

Approximately one quarter of the earth's population directly harvests natural resources to meet their daily needs. These individuals are disproportionately required to alter their behaviors in response to increasing climatic variability and global biodiversity loss. Much of the ever-ambitious global conservation agenda relies on the voluntary uptake of conservation behaviors in such populations. Thus, it is critical to understand how such individuals perceive environmental change and use conservation practices as a tool to protect their well-being. We developed a participatory mapping activity to elicit spatially explicit perceptions of forest change and its drivers across 43 mangrove-dependent communities in Pemba, Tanzania. We administered this activity along with a questionnaire regarding conservation preferences and behaviors to 423 individuals across those 43 communities. We analyzed these data with a set of Bayesian hierarchical statistical models. Perceived cover loss in 50% of a community's mangrove area drove individuals to decrease proposed limits on fuelwood bundles from 2.74 (forest perceived as intact) to 2.37 if participants believed resultant gains in mangrove cover would not be stolen by outsiders. Conversely, individuals who believed their community mangrove forests were at high risk of theft loosened their proposed harvest limits from 1.26 to 2.75 bundles of fuelwood in response to the same perceived forest decline. High rates of intergroup competition and mangrove loss were thus driving a self-reinforcing increase in unsustainable harvesting preferences in community forests in this system. This finding demonstrates a mechanism by which increasing environmental decline may cause communities to forgo conservation practices, rather than adopt them, as is often assumed in much community-based conservation planning. However, we also found that when effective boundaries were present, individuals were willing to limit their own harvests to stem such perceived decline.

Efectos de las percepciones del cambio forestal y la competencia intergrupal en los comportamientos de conservación comunitarios Resumen Aproximadamente una cuarta parte de la población mundial aprovecha directamente los recursos naturales para satisfacer sus necesidades diarias. Estos individuos se ven desproporcionadamente obligados a alterar sus comportamientos en respuesta a la creciente variabilidad climática y la pérdida de biodiversidad global. Gran parte de la ambiciosa agenda de conservación global se basa en la adopción voluntaria de comportamientos de conservación en dichas poblaciones. Por lo tanto, es fundamental comprender cómo esas personas perciben el cambio ambiental y utilizan las prácticas de conservación como herramienta para proteger su bienestar. Desarrollamos una actividad de mapeo participativo para generar percepciones espacialmente explícitas del cambio forestal y sus causantes en 43 comunidades dependientes de manglares en Pemba, Tanzania. Administramos esta actividad junto con un cuestionario sobre preferencias y comportamientos de conservación a 423 personas en esas 43 comunidades. Analizamos estos datos mediante un conjunto de modelos estadísticos jerárquicos bayesianos. La pérdida de cobertura percibida en el 50% del área de manglares de una comunidad llevó a los individuos a reducir los límites propuestos para los paquetes de leña de 2.74 (bosque percibido como intacto) a 2.37 si los participantes creían que las ganancias resultantes en la cobertura de manglares no serían robadas por personas ajenas a la comunidad. Por el contrario, las personas que creían que los bosques de manglares de su comunidad corrían un alto riesgo de robo flexibilizaron los límites de cosecha propuestos de 1.26 a 2.75 haces de leña en respuesta a la misma disminución percibida del bosque. Por lo tanto, las altas tasas de competencia entre grupos y pérdida de manglares estaban impulsando un aumento, que se auto reforzaba, en las preferencias de aprovechamiento insostenibles en los bosques comunitarios de este sistema. Este hallazgo muestra un mecanismo por el cual el creciente deterioro ambiental puede hacer que las comunidades renuncien a las prácticas de conservación, en lugar de adoptarlas, como a menudo se supone en gran parte de la planificación de la conservación basada en la comunidad. Sin embargo, también encontramos que cuando existían límites efectivos, los individuos estaban dispuestos a restringir sus propias cosechas para frenar esa disminución percibida.

Unlocking the Potential: Investigating Dental Practitioners' Willingness to Embrace Artificial Intelligence in Dental Practice.

BACKGROUND: Artificial intelligence (AI) holds significant promise for transforming healthcare delivery, including dentistry. However, the successful integration of AI into dental practice necessitates an understanding of dental professionals' perspectives, attitudes, and readiness to adopt AI technology. This study aimed to explore dental professionals' perceptions, attitudes, and practices regarding AI adoption in dentistry. METHODS: This cross-sectional study was conducted among 256 dental professionals using an online questionnaire. Participants were assessed for familiarity with AI technology, perceived barriers to adoption, attitudes towards AI, current usage patterns, and factors influencing adoption decisions. Data are analysed using descriptive statistics, including frequencies, percentages, means, and standard deviations. Inferential statistics, such as chi-square tests and regression analysis, were employed to examine associations between variables and identify predictors of AI adoption in dentistry. RESULTS: The study surveyed 256 dental professionals from various regions across India, primarily aged 30 to 50 years (mean age: 42.6), with a nearly equal gender split (male: 48.4%, female: 51.6%) and high educational attainment (67.8% with master's or doctoral degrees). Private practices were predominant (56.3%). The diagnostic algorithms and treatment planning software were well known (77.3% and 70.3% familiarity, respectively). Technical concerns (average score: 3.82 ± 0.68) were the main barriers to AI adoption, followed by financial considerations (average score: 3.45 ± 0.72), ethical and legal issues (average score: 3.21 ± 0.65), and organizational factors (average score: 3.67 ± 0.71). Despite these concerns, most participants had positive attitudes towards AI (70.3% agreed). Current usage varied, with diagnostic support and administrative tasks being the most common (44.5% and 82.8% usage, respectively). Perceived utility (average score: 4.12 ± 0.75) and ease of use (average score: 3.98 ± 0.69) significantly influenced adoption, as identified by regression analysis (perceived utility: ß = 0.342, p < 0.001; ease of use: ß = 0.267, p = 0.005). CONCLUSION: This study provides valuable insights into AI adoption in dentistry, highlighting the multifaceted nature of barriers and facilitators that influence dental professionals' adoption decisions. Strategies to promote AI adoption should address practical considerations, ethical concerns, and educational needs to facilitate the integration of AI technology into dental practices.

Findings from the Promoting Independence in Dementia App (PRIDE-app) Study a Reach, Effectiveness, Adoption, Implementation, and Maintenance Framework Discussion.

INTRODUCTION: Self-management is pivotal in helping people with their independence and in managing their health conditions more effectively. The PRIDE-app is a novel online intervention, providing support and information for people living with dementia and their families, aimed at increasing self-management and improving quality of life. Knowledge generated will help inform future developments to the app, with the aim of improving its uptake and implementation in services. METHODS: A mixed-methods approach incorporating the RE-AIM framework. Recruited 25 people living with dementia, of which 17completed the PRIDE-app intervention over 8 weeks with support from a dementia adviser facilitator. Measures exploring mood, physical well-being, and quality of life were collected at baseline, 3 and 6 months and analysed through modelled analysis. Post-intervention interviews were conducted with participants and facilitators and analysed through thematic analysis. RESULTS: Quantitative results did not show significant improvements in participants' scores. Qualitative data showed that the PRIDE-app motivated people to reconnect socially and set individual goals for activities. Participants and facilitators identified areas for improvements to the app interface and delivery format. CONCLUSIONS: This study evaluated the PRIDE-app's reach, effectiveness and adoptability in the independence and quality of life of people living with dementia, as well as how it could be implemented and maintained within services. Pre- and post-intervention scores were inconclusive. Interviews provided positive feedback of the app's influence on peoples' activities and mood.

Longitudinal Monitoring of Clinician-Patient Video Visits During the Peak of the COVID-19 Pandemic: Adoption and Sustained Challenges in an Integrated Health Care Delivery System.

BACKGROUND: Numerous prior opinion papers, administrative electronic health record data studies, and cross-sectional surveys of telehealth during the pandemic have been published, but none have combined assessments of video visit success monitoring with longitudinal assessments of perceived challenges to the rapid adoption of video visits during the pandemic. OBJECTIVE: This study aims to quantify (1) the use of video visits (compared with in-person and telephone visits) over time during the pandemic, (2) video visit successful connection rates, and (3) changes in perceived video visit challenges. METHODS: A web-based survey was developed for the dual purpose of monitoring and improving video visit implementation in our health care system during the COVID-19 pandemic. The survey included questions regarding rates of in-person, telephone, and video visits for clinician-patient encounters; the rate of successful connection for video visits; and perceived challenges to video visits (eg, software, hardware, bandwidth, and technology literacy). The survey was distributed via email to physicians, advanced practice professionals, and clinicians in May 2020. The survey was repeated in March 2021. Differences between the 2020 and 2021 responses were adjusted for within-respondent correlation across surveys and tested using generalized estimating equations. RESULTS: A total of 1126 surveys were completed (511 surveys in 2020 and 615 surveys in 2021). In 2020, only 21.7% (73/336) of clinicians reported no difficulty connecting with patients during video visits and 28.6% (93/325) of clinicians reported no difficulty in 2021. The distribution of the percentage of successfully connected video visits ("Over the past two weeks of scheduled visits, what percentage did you successfully connect with patients by video?") was not significantly different between 2020 and 2021 (P=.74). Challenges in conducting video visits persisted over time. Poor connectivity was the most common challenge reported by clinicians. This response increased over time, with 30.5% (156/511) selecting it as a challenge in 2020 and 37.1% (228/615) in 2021 (P=.01). Patients not having access to their electronic health record portals was also a commonly reported challenge (109/511, 21.3% in 2020 and 137/615, 22.3% in 2021, P=.73). CONCLUSIONS: During the pandemic, our health care delivery system rapidly adopted synchronous patient-clinician communication using video visits. As experience with video visits increased, the reported failure rate did not significantly decline, and clinicians continued to report challenges related to general network connectivity and patient access to technology.

Adoption as an Alternative Family-Building Strategy: Perceptions of Female, Young Adult Cancer Survivors Receiving Gonadotoxic Treatments.

Female survivors of young adult (YA) cancers are at risk of fertility impacts following cancer treatment. For these women, fertility-related distress is both prevalent and persistent. Yet there is little research regarding survivors' perspectives on alternative family-building options, particularly adoption. This exploratory secondary data analysis analyzed semistructured interviews and explored survivors' views of adoption. Overall, female YA survivors reported openness to adoption as a possible substitute for biological conception and an alternative to fertility preservation. It is imperative that this population receives support in decision-making around and consideration of the unique barriers to adoption for cancer survivors.

Factors affecting metaverse adoption in education: A systematic review, adoption framework, and future research agenda.

The Metaverse, underpinned by its technical infrastructure, heavily relies on user engagement and behavior for successful integration into educational settings. Understanding its driving factors is essential for such a platform to transition from theory to practice, especially in educational settings. However, these factors remain elusive due to inconsistencies in infrastructure and environments. Therefore, this systematic review aims to fill this void by presenting an integrative view on Metaverse adoption in education. This is achieved via three primary dimensions: establishing a taxonomy of the factors influencing Metaverse adoption in education, proposing a framework for Metaverse adoption, and suggesting future research trajectories in this domain. The review systematically classifies the influential factors into four distinct categories: psychological and motivational factors, quality factors, social factors, and inhibiting factors. The proposed framework provides a structured approach for future studies investigating the Metaverse adoption in educational settings. The proposed framework also emphasizes that educational institutions should not only consider the technical prerequisites but also the social, psychological, and motivational aspects of the Metaverse. The study also pinpoints several critical research agendas to enhance our understanding of Metaverse adoption in education. The insights from this review are invaluable for educational institutions, policymakers, developers, and researchers, significantly enriching the emerging field of Metaverse adoption.

Do investments in phosphorus recovery from dairy processing wastewater pay off?

While phosphorus fertilizers contribute to food security, part of the introduced phosphorus dissipates into water bodies leading to eutrophication. At the same time, conventional mineral phosphorus sources are increasingly scarce. Therefore, closing phosphorus cycles reduces pollution while decreasing trade dependence and increasing food security. A major part of the phosphorus loss occurs during food processing. In this article, we combine a systematic literature review with investment and efficiency analysis to investigate the financial feasibility of recovering phosphorus from dairy processing wastewater. This wastewater is particularly rich in phosphorus, but while recovery technologies are readily available, they are rarely adopted. We calculate the Net Present Value (NPV) of investing in phosphorus recycling technology for a representative European dairy processing company producing 100,000 tonnes of milk per year. We develop sensitivity scenarios and adjust the parameters accordingly. Applying struvite precipitation, the NPV can be positive in two scenarios. First, if the phosphorus price is high (1.51 million EUR) or second if phosphorus recovery is a substitute for mandatory waste disposal (1.48 million EUR). However, for a variety of methodological specifications, the NPV is negative, mainly because of high input costs for chemicals and energy. These trade-offs between off-setting pollution and reducing energy consumption imply, that policy makers and investors should consider the energy source for phosphorus recovery carefully.

The Detection of Environmental Influences on Academic Achievement Appears to Depend on the Analytic Approach.

One long-standing analytic approach in adoption studies is to examine correlations between features of adoptive homes and outcomes of adopted children (hereafter termed 'measured environment correlations') to illuminate environmental influences on those associations. Although results from such studies have almost uniformly suggested modest environmental influences on adopted children's academic achievement, other work has indicated that adopted children's achievement is routinely higher than that of their reared-apart family members, often substantially so. We sought to understand this discrepancy. We examined academic achievement and literacy-promotive features of the home in 424 yoked adoptive/biological families participating in the Early Growth and Development Study (EGDS; i.e., adopted children, adoptive mothers, birth mothers, and biological siblings of the adopted children remaining in the birth homes) using an exhaustive modeling approach. Results indicated that, as anticipated, adopted children scored up to a full standard deviation higher on standardized achievement tests relative to their birth mothers and reared-apart biological siblings. Moreover, these achievement differences were associated with differences in the literacy-promotive features of the adoptive and birth family homes, despite minimal measured environment correlations within adoptive families. A subsequent simulation study highlighted noise in measured environmental variables as an explanation for the decreased utility of measured environment correlations. We conclude that the field's heavy focus on measured environment correlations within adoptive families may have obscured detection of specific environmental effects on youth outcomes, and that future adoption studies should supplement their measured environment analyses with mean differences between reared-apart relatives.

A Self-Guided Web-Based App (MyDiaMate) for Enhancing Mental Health in Adults With Type 1 Diabetes: Insights From a Real-World Study in the Netherlands.

BACKGROUND: MyDiaMate is a web-based intervention specifically designed for adults with type 1 diabetes (T1D) that aims to help them improve and maintain their mental health. Prior pilot-testing of MyDiaMate verified its acceptability, feasibility, and usability. OBJECTIVE: This study aimed to investigate the real-world uptake and usage of MyDiaMate in the Netherlands. METHODS: Between March 2021 and December 2022, MyDiaMate was made freely available to Dutch adults with T1D. Usage (participation and completion rates of the modules) was tracked using log data. Users could volunteer to participate in the user profile study, which required filling out a set of baseline questionnaires. The usage of study participants was examined separately for participants scoring above and below the cutoffs of the "Problem Areas in Diabetes" (PAID-11) questionnaire (diabetes distress), the "World Health Organization Well-being Index" (WHO-5) questionnaire (emotional well-being), and the fatigue severity subscale of the "Checklist Individual Strength" (CIS) questionnaire (fatigue). Two months after creating an account, study participants received an evaluation questionnaire to provide us with feedback. RESULTS: In total, 1008 adults created a MyDiaMate account, of whom 343 (34%) participated in the user profile study. The mean age was 43 (SD 14.9; 18-76) years. Most participants were female (n=217, 63.3%) and higher educated (n=198, 57.6%). The majority had been living with T1D for over 5 years (n=241, 73.5%). Of the study participants, 59.1% (n=199) of them reported low emotional well-being (WHO-5 score≤50), 70.9% (n=239) of them reported elevated diabetes distress (PAID-11 score≥18), and 52.4% (n=178) of them reported severe fatigue (CIS score≥35). Participation rates varied between 9.5% (n=19) for social environment to 100% (n=726) for diabetes in balance, which opened by default. Completion rates ranged from 4.3% (n=1) for energy, an extensive cognitive behavioral therapy module, to 68.6% (n=24) for the shorter module on hypos. There were no differences in terms of participation and completion rates of the modules between study participants with a more severe profile, that is, lower emotional well-being, greater diabetes distress, or more fatigue symptoms, and those with a less severe profile. Further, no technical problems were reported, and various suggestions were made by study participants to improve the application, suggesting a need for more personalization. CONCLUSIONS: Data from this naturalistic study demonstrated the potential of MyDiaMate as a self-help tool for adults with T1D, supplementary to ongoing diabetes care, to improve healthy coping with diabetes and mental health. Future research is needed to explore engagement strategies and test the efficacy of MyDiaMate in a randomized controlled trial.

Feasibility and Acceptability of Pediatric Smartphone Lung Auscultation by Parents: Cross-Sectional Study.

Background: The use of a smartphone built-in microphone for auscultation is a feasible alternative to the use of a stethoscope, when applied by physicians. Objective: This cross-sectional study aims to assess the feasibility of this technology when used by parents-the real intended end users. Methods: Physicians recruited 46 children (male: n=33, 72%; age: mean 11.3, SD 3.1 y; children with asthma: n=24, 52%) during medical visits in a pediatric department of a tertiary hospital. Smartphone auscultation using an app was performed at 4 locations (trachea, right anterior chest, and right and left lung bases), first by a physician (recordings: n=297) and later by a parent (recordings: n=344). All recordings (N=641) were classified by 3 annotators for quality and the presence of adventitious sounds. Parents completed a questionnaire to provide feedback on the app, using a Likert scale ranging from 1 ("totally disagree") to 5 ("totally agree"). Results: Most recordings had quality (physicians' recordings: 253/297, 85.2%; parents' recordings: 266/346, 76.9%). The proportions of physicians' recordings (34/253, 13.4%) and parents' recordings (31/266, 11.7%) with adventitious sounds were similar. Parents found the app easy to use (questionnaire: median 5, IQR 5-5) and were willing to use it (questionnaire: median 5, IQR 5-5). Conclusions: Our results show that smartphone auscultation is feasible when performed by parents in the clinical context, but further investigation is needed to test its feasibility in real life.

Individuals' attitudes toward digital mental health apps and implications for adoption in Portugal: web-based survey.

BACKGROUND: The literature is consensual regarding the academic community exhibiting higher levels of mental disorder prevalence than the general population. The potential of digital mental health apps for improving access to resources to cope with these issues is ample. However, studies have yet to be performed in Portugal on individuals' attitudes and perceptions toward digital mental health applications or their preferences and decision drivers on obtaining mental health care, self-assessment, or treatment. OBJECTIVE: This study aims to understand the determinants of digital mental health applications use in the Portuguese academic community of Porto, along with potential adoption barriers and enablers. METHODS: A cross-sectional, web-based survey was delivered via dynamic email to the University of Porto's academic community. Data collection occurred between September 20 and October 20, 2022. We used structural equation modeling to build three models, replicating a peer-reviewed and published study and producing a newly full mediation model shaped by the collected data. We tested the relationships between use of digital mental health apps and perceived stress, perceived need to seek help for mental health, perceived stigma, past use of mental health services, privacy concerns, and social influence. RESULTS: Of the 539 participants, 169 (31.4%) reported having used digital mental health apps. Perceived stress and a latent variable, comprising perceptions of mental health problems and coping strategies, were positively associated with mental health app use, while privacy concerns regarding one's information being accessible to others were negatively associated. Perceived stigma, need to seek help, and close relationships did not have a statistically significant direct effect. CONCLUSIONS: These findings can inform product and policy development of new, better-targeted digital mental health app interventions, with implications for researchers and academia, industry, and policymakers. Our study concludes that, to maximize adherence to these apps, they should have low to no financial charges, demonstrate evidence of their helpfulness and focus on the timely delivery of care. We also conclude that to foster digital mental health app use, there is a need to improve mental health literacy, namely regarding self-awareness of one's conditions, acceptable stress levels, and overall behavior towards mental health. TRIAL REGISTRATION: RR2-10.2196/41040.

Usage Behaviour and Adoption Criteria for Mobile Health Solutions in Patients with Chronic Diseases in Gastroenterology.

Introduction: Mobile Health (mHealth) applications allow for new possibilities and opportunities in patient care. Their potential throughout the whole patient journey is undisputed. However, the eventual adoption by patients depends on their acceptance of and motivation to use mHealth applications as well as their adherence. Therefore, we investigated the motivation and drivers of acceptance for mHealth and developed an adapted model of the Unified Theory of Acceptance and Use of Technology (UTAUT2). Methods: We evaluated 215 patients with chronic gastroenterological diseases who answered a questionnaire including all model constructs with 7-point Likert scale items. Our model was adapted from the Unified Theory of Acceptance and Use in Technology 2 and includes influencing factors such as facilitating conditions, performance expectancy, hedonic motivation, social influence factors, effort expectancy, as well as personal empowerment and data protection concerns. Model evaluation was performed with structural equation modelling with PLS-SEM. Bootstrapping was performed for hypothesis testing. Results and Conclusion: Patients had a median age of 55.5 years, and the gender ratio was equally distributed. Forty percent received a degree from a university, college, technical academy, or engineering school. The majority of patients suffered from chronic liver disease, but patients with inflammatory bowel diseases, GI cancers, and pancreatic diseases were also included. Patients considered their general technology knowledge as medium to good or very good (78%). Actual usage of mHealth applications in general was rare, while the intention to use them was high. The leading acceptance factor for mHealth applications in our patient group was feasibility, both in terms of technical requirements and the intuitiveness and manageability of the application. Concerns about data privacy did not significantly impact the intention to use mobile devices. Neither the gamification aspect nor social influence factors played a significant role in the intention to use mHealth applications. Interpretation: Most of our patients were willing to spend time on a mHealth application specific to their disease on a regular basis. Acceptance and adherence are ensured by efficient utilization that requires minimum effort and compatible technologies as well as support in case of difficulties. Social influence and hedonic motivation, which were part of UTAUT2, as well as data security concerns, were not significantly influencing our patients' intention to use mHealth applications. A literature review revealed that drivers of acceptance vary considerably among different population and patient groups. Therefore, healthcare and mHealth providers should put effort into understanding their specific target groups' drivers of acceptance. We provided those for a cohort of patients from gastroenterology in this project.