La inteligencia artificial en la prevención de conductas suicidas: aspectos técnicos y consideraciones ético-legales / La intelligència artificial en la prevenció de conductes suïcides: aspectes tècnics i consideracions ètico-legals / Artificial intelligence in the prevention of suicidal behaviour: Technical aspects and ethical-legal considerations

En este artículo reflexionamos sobre la potencialidad terapéutica de los nuevos desarrollos de la Inteligencia Artificial en el ámbito de la salud mental, en particular en la prevención de conductas suicidas. En primer lugar, analizamos los aspectos tecno-científicos más relevantes del Machine Learning en el entorno de las Redes Sociales, las aplicaciones móviles y los chatbots, así como las ventajas e inconvenientes de esta nueva Psiquiatría Computacional. A continuación, consideramos los límites y dificultades en el uso de estas tecnologías desde una perspectiva ética, además del marco legal para que estas aplicaciones preventivas sean garantistas en lo que a eficacia, seguridad, privacidad, transparencia, responsabilidad y equidad se refiere. Si bien las amenazas son considerables, concluimos que con una correcta identificación y gestión de las mismas el alcance terapéutico de estas herramientas se antoja alentador.(AU)

En aquest article reflexionem sobre la potencialitat terapèutica dels nous desenvolupaments de la Intel·ligència Artificial en l'àmbit de la salut mental, especialment en la prevenció de conductes suïcides. En primer lloc, analitzem els aspectes tecno-científics més rellevants de l'Aprenentatge Automàtic en l'entorn de les Xarxes Socials, les aplicacions mòbils i els chatbots, així com els avantatges i inconvenients d'aquesta nova Psiquiatria Computacional. A continuació, considerem els límits i les dificultats en l'ús d'aquestes tecnologies des d'una perspectiva ètica, a més del marc legal perquè aquestes aplicacions preventives siguin garantistes en qüestions d'eficàcia, seguretat, privadesa, transparència, responsabilitat i equitat. Toti que les amenaces són considerables, concloem que amb una correcta identificació i gestió d'aquestes, el potencial terapèutic d'aquestes eines sembla prometedor.(AU)

In this article we reflect on the therapeutic potential of the new developments of Artificial Intelligence in the field of mental health, particularly in the prevention of suicidal behavior. First, we analyze the most relevant techno-scientific aspects of Machine Learning in the environment of Social Networks, mobile applications and chatbots, as well as the advantages and disadvantages of this new computational psychiatry. Next, we consider the limits and difficulties in the use of these technologies from an ethical perspective, in addition to the legal framework so that these preventive applications are guarantees in terms of efficacy, security, privacy, transparency, responsibility and fairness. Although the threats are considerable, we conclude that with proper identification and management of them, the therapeutic scope of these tools seems encouraging.(AU)

Aplicación de las nuevas tecnologías en Atención Primaria en el control del paciente con sobrepeso u obesidad y factores de riesgo cardiovascular / Application of new technologies in Primary Care to monitor overweight or obese patients with cardiovascular risk factor

El objetivo es evaluar un seguimiento telemático (web o aplicación [app]) para pacientes con sobrepeso/obesidad y otros dos factores de riesgo cardiovascular: hipertensión arterial (HTA), dislipemia, diabetes mellitus (DM), sedentarismo, consumo tabáquico. Diseño: es un estudio de intervención con asignación aleatoria al grupo intervención (web o app) y al grupo control. Emplazamiento: centros de salud rurales y urbanos, docentes y no docentes, del Sector Zaragoza I. Participantes: 261 personas con índice de masa corporal (IMC) > 25 kg/m2 y otros dos factores de riesgo. Intervenciones: seguimiento de 18 meses con puntos de corte al inicio, 1, 6, 12 y 18 meses. Las mediciones principales son peso, tensión arterial, consumo tabáquico, eventos cardiovasculares, calidad de vida y bioquímica. Resultados: el grupo control finalizó el estudio en mayor proporción (79% versus 14%). El grupo control consiguió una pérdida del 8% de la mediana de peso al año y el grupo intervención un 5%. A los 6 meses, el grupo control logró disminuir el 7% la tensión arterial sistólica y el 5% la diastólica. La hemoglobina glicosilada (HbA1c) descendió un 1% en el grupo control y un 0,5% en el grupo intervención (test de Wilcoxon: 10; p = 0,089). El colesterol de lipoproteínas de baja densidad (cLDL) del grupo control descendió 9 mg/dL, y el del grupo intervención, 7 mg/dl (test de Wilcoxon: 1.089; p = 0,018). El hábito tabáquico disminuyó en todos los grupos (test de Wilcoxon: 21; p = 0,036). El grupo control presentó mayor prevalencia de eventos cardiovasculares. La calidad de vida mejoró en todos los grupos (test Wilcoxon: 979; p = 0,041). Conclusiones: las/los pacientes que acuden al centro de salud para un seguimiento de peso consiguen mejores resultados que si el seguimiento se hace de forma telemática.(AU)

The aim was to evaluate remote assistance (Web or App) for overweight/obese patients with two extra cardiovascular risk factors: hypertension, dyslipidemia, diabetes, smoking, sedentary lifestyle. Design: intervention study using random assignment for Web Group and App Group. The App Group was subsequently selected. Location: urban and rural health centres, teaching and non-teaching centres, in the Zaragoza I health area. Subjects: 261 people with BMI> 25 Kg/m2 and two extra cardiovascular risk factors. Interventions: 18 months follow up, initial checkups and after 1, 6, 12 and 18 months. The primary endpoints were: weight, blood pressure, tobacco consumption, cardiovascular events, quality of life and blood tests. Results: The control group completed the study in a higher proportion (79% vs 14%). The control and intervention groups attained a loss of 8% in and 5% median weight per year, respectively. After 6 months, the control group managed to reduce systolic and diastolic blood pressure by 7% and 5%, respectively. Glycosidic haemoglobin was 1% and 0.5% lower in the control and intervention groups, respectively (Wilcoxon Test=10; P= 0.089). Both groups reduced tobacco consumption (Wilcoxon=21; P=0.03). The control group had a higher prevalence of cardiovascular events. Quality of life improved (Wilcoxon Test=979; P=0.041). Conclusion: Patients visiting health centres to monitor weight obtain better results than those remotely assisted.(AU)

The integration of mHealth technologies in telemedicine during the COVID-19 era: A cross-sectional study.

Telemedicine is a rapidly expanding field of medicine and an alternative method for delivering quality medical care to patients' fingertips. With the COVID-19 pandemic, there has been an increase in the use of telemedicine to connect patients and healthcare providers, which has been made possible by mobile health (mHealth) applications. The goal of this study was to compare the satisfaction of patients with telemedicine among mHealth users and non-users. This was a survey-based study that included outpatients from Abu Dhabi. The association between patient satisfaction with telemedicine and use of mHealth technologies was described using regression models. This study included a total of 515 completed responses. The use of mHealth application was significantly associated with ease of booking telemedicine appointments (OR 2.61, 95% CI 1.63-4.18; P < .001), perception of similarity of quality of care between telemedicine consultations and in-person visits (OR 1.81, 95% CI 1.26-2.61; P = .001), and preference for using telemedicine applications over in-person visits during the COVID-19 pandemic (OR 1.74, 95% CI 1.12-2.72; P = .015). Our study results support that the use of mHealth applications is associated with increased patient satisfaction with telemedicine appointments.

Smartphone-Based Screening for Cardiovascular Diseases: A Trend?

Abstract Cardiovascular diseases are the leading cause of death in the world. People living in vulnerable and poor places such as slums, rural areas and remote locations have difficulty in accessing medical care and diagnostic tests. In addition, given the COVID-19 pandemic, we are witnessing an increase in the use of telemedicine and non-invasive tools for monitoring vital signs. These questions motivate us to write this point of view and to describe some of the main innovations used for non-invasive screening of heart diseases. Smartphones are widely used by the population and are perfect tools for screening cardiovascular diseases. They are equipped with camera, flashlight, microphone, processor, and internet connection, which allow optical, electrical, and acoustic analysis of cardiovascular phenomena. Thus, when using signal processing and artificial intelligence approaches, smartphones may have predictive power for cardiovascular diseases. Here we present different smartphone approaches to analyze signals obtained from various methods including photoplethysmography, phonocardiograph, and electrocardiography to estimate heart rate, blood pressure, oxygen saturation (SpO2), heart murmurs and electrical conduction. Our objective is to present innovations in non-invasive diagnostics using the smartphone and to reflect on these trending approaches. These could help to improve health access and the screening of cardiovascular diseases for millions of people, particularly those living in needy areas.

A clinical trial to evaluate the dayzz smartphone app on employee sleep, health, and productivity at a large US employer.

Sleep deficiency is a hidden cost of our 24-7 society, with 70% of adults in the US admitting that they routinely obtain insufficient sleep. Further, it is estimated that 50-70 million adults in the US have a sleep disorder. Undiagnosed and untreated sleep disorders are associated with diminished health for the individual and increased costs for the employer. Research has shown that adverse impacts on employees and employers can be mitigated through sleep health education and sleep disorder screening and treatment programs. Smartphone applications (app) are increasingly commonplace and represent promising, scalable modalities for such programs. The dayzz app is a personalized sleep training program that incorporates assessment of sleep disorders and offers a personalized comprehensive sleep improvement solution. Using a sample of day workers affiliated with a large institution of higher education, we will conduct a single-site, parallel-group, randomized, waitlist control trial. Participants will be randomly assigned to either use the dayzz app throughout the study or receive the dayzz app at the end of the study. We will collect data on feasibility and acceptability of the dayzz app; employee sleep, including sleep behavioral changes, sleep duration, regularity, and quality; employee presenteeism, absenteeism, and performance; employee mood; adverse and safety outcomes; and healthcare utilization on a monthly basis throughout the study, as well as collect more granular daily data from the employee during pre-specified intervals. Our results will illuminate whether a personalized smartphone app is a viable approach for improving employee sleep, health, and productivity. Trial registration: ClinicalTrials.gov Identifier: NCT04224285.

O uso de smartphones como ferramenta de aprendizado por estudantes de Odontologia / The use of smartphones as a learning tool by dental students

As tecnologias podem ser potentes facilitadoras do processo de aprendizagem dos alunos, principalmente nas gerações atuais. Os smartphonessão ferramentas rotineiramente utilizadas a qualquer momento e em qualquer lugar na busca de variadas informações. Assim, a aquisição de conhecimento por meiodeste dispositivo móvel, alinhada com as perspectivas de ensino e resultados esperados para o aprendizado, parece fazer cada vez mais sentido. Neste contexto, este estudo foi proposto com o objetivo de conhecer o perfil do uso de smartphones como ferramenta de aprendizagem ativa e móvel por estudantes de Odontologia. Trata-se de um estudo transversal, realizado por meiode um questionário eletrônico, composto por perguntas objetivas e abertas, as quais avaliaram características sociodemográficas, tipo de aparelho e conexão, usogerale para aprendizado odontológico, bem como aatitude dos alunos em relação ao uso. Do total de estudantes elegíveis ao estudo, 169 alunos responderam ao questionário (taxa de resposta de 49,1%). A maioria dos participantes eram mulheres, com faixa etária de 19 a 21 anos. Todos os estudantes afirmaram ter smartphone, com conexão à internet. Os principais usos descritos foram relacionados à comunicação, gerenciamento de tempo e educação. As vantagens relatadas foram praticidade, flexibilidade de uso, acesso a diferentes conteúdos, capacidade de pesquisar informações e de se comunicar rapidamente. Os desafios identificados incluíram distração e excesso de uso. Os resultados permitiram concluir que os estudantes utilizam os smartphonescomo ferramenta de aprendizagem ativa, principalmente, para acessar e-books, artigos científicos, escutar podcasts,assistir livese visualizar publicações de conteúdos teóricos e práticos no Instagram (AU).

Technologies can be powerful and helpful tools for students' learning process, especially for the current generations. Smartphones are routinely used to search for a wide rangeof information, at anytime and anywhere. Thus, knowledge acquisition through this mobile device, for teaching and learning outcomes, seems to increasingly make more and more sense. Therefore, the aim of thisstudy was to understand the profile of the use of smartphones as an active learning tool by dental students. The data of this cross-sectional study was collected by an electronic questionnaire, with open and closed questions regarding the socio-demographic characteristics, type of device and connection, general use for dentallearning, as well as the students' attitudes towards the use of smartphone for learning. Out of the total number of students eligible for the study, 169 students responded to the questionnaire (response rate of 49.1%). Most participants were women, aged between 19 and 21 years. All students declaredtohave a smartphone, with internet connection. The main uses described were related to communication, time management,and education. The advantages pointed out by the participants were convenience, flexibility of use, access to different contents in different ways, ability to search for information,and rapid communication. The main challenges included distraction and overuse. The results of this study demonstrate that students use smartphones as an active learning tool, mainly to access e-books, scientific articles, to listen to podcasts, watch lives,and view publications of theoretical and practical content on Instagram (AU).

AUDCRED: ferramenta de apoio para auditoria de contas em saúde / AUDCRED: support tool for auditing health accounts

Introdução: Uma das ferramentas de qualidade mais eficientes para monitorar um sistema de gestão é a auditoria, pois, quando bem aplicada, diagnostica não conformidades no serviço avaliado, sendo executada por profissionais capacitados que apresentam, além do conhecimento técnico-científico, atributos pessoais como imparcialidade, prudência e diplomacia. Objetivos: O objetivo geral do estudo foi desenvolver uma ferramenta móvel que possa servir de apoio para o processo de auditoria de contas médicas e os objetivos específicos foram: identificar os requisitos necessários para o desenvolvimento da ferramenta de auditoria; apresentar um protótipo e desenvolver uma ferramenta garantindo os requisitos de segurança necessários à manutenção da informação pessoal, possibilitando sua implementação, distribuição e modificação e avaliar o impacto da ferramenta para a auditoria em saúde no âmbito da Marinha do Brasil. Método: Trata-se de um estudo descritivo, exploratório, de abordagem qualitativa, aplicado à produção tecnológica e destinado a desenvolver uma ferramenta informatizada móvel para apoio ao serviço de auditoria de contas médicas. Para desenvolvimento da ferramenta foi utilizada a metodologia de Pressman, seguindo as seguintes etapas: coleta e refinamento dos requisitos, elaboração de projeto rápido, construção do protótipo, avaliação pelo cliente e posterior refinamento quando há necessidade de ajustes finais do projeto, com o intuito de satisfazer da melhor forma as necessidades dos clientes. Resultados: Foram distribuídos 75 formulários para os auditores da Marinha e, tendo sido respondidos 65 (84,3%), observou-se que 40,9% dos entrevistados eram enfermeiros e 29% não tinham experiência em auditoria. As falas dos entrevistados foram analisadas, emergindo cinco categorias relacionadas a melhorias e uma a crítica, sendo estas respectivamente: ampliar o módulo para controle e previsão de custos; regular os serviços que serão prestados pela contratada; orientar profissionais a executarem a auditoria em saúde; ampliar módulo para que possam ser apresentados indicadores e relatório; disponibilizar mais informações sobre os credenciados e não entender o propósito da ferramenta. Conclusão: Acredita-se que a ferramenta irá contribuir para que os auditores recém-ingressos na Marinha possam executar o processo de auditoria de acordo com a técnica, gerando uniformidade, dando celeridade e, principalmente, evitando perdas para a organização. Dessa forma, favorecendo ao profissional mais habilidade e destreza em todo processo

Introduction: One of the most efficient quality tools to monitor a management system is the audit, because, when properly applied, it diagnoses non-conformities in the service evaluated, being performed by trained professionals who have, in addition to technical-scientific knowledge, personal attributes such as impartiality, prudence and diplomacy. The general objective of the study was to develop a mobile tool that can support the medical bills audit process and the specific. Objectives: The general objective of the study was to develop a mobile tool that can support the medical bill audit process and the specific objectives were: to identify the necessary requirements for the development of the audit tool; present a prototype and develop a tool ensuring the security requirements necessary for the maintenance of personal information, enabling its implementation, distribution and modification, and evaluating the impact of the tool for health auditing within the Brazilian Navy.Method: This is a descriptive, exploratory study with a qualitative approach applied to technological production, aimed at developing a mobile computerized tool to support the medical bill audit service. For development of the tool, Pressman's methodology was used, following the steps: collection and refinement of requirements, rapid design development, prototype construction, customer evaluation and further refinement when there is a need for final design adjustments, in order to satisfy the best way to meet the needs of customers. Results: 75 forms were distributed to the Navy auditors, with 65 (84.3%) answered, it was observed that 40.9% of respondents were nurses, 29.% had no experience in auditing. The speeches of the interviewees were analyzed emerging five categories related to improvements and one the criticism, respectively: expanding the module for cost control and forecasting; regulate the services that will be provided by the contractor; guide professionals to perform the health audit; expand module so that indicators and report can be presented; provide more information about the accredited and do not understand the purpose of the tool. Conclusion: It is believed that the tool will help auditors who have recently joined the Navy to perform the audit process according to the technique, generating uniformity, speeding up and, above all, avoiding losses for the organization. In this way, providing the professional with more skill and dexterity throughout the process

Mobile health and privacy: cross sectional study.

OBJECTIVES: To investigate whether and what user data are collected by health related mobile applications (mHealth apps), to characterise the privacy conduct of all the available mHealth apps on Google Play, and to gauge the associated risks to privacy. DESIGN: Cross sectional study SETTING: Health related apps developed for the Android mobile platform, available in the Google Play store in Australia and belonging to the medical and health and fitness categories. PARTICIPANTS: Users of 20 991 mHealth apps (8074 medical and 12 917 health and fitness found in the Google Play store: in-depth analysis was done on 15 838 apps that did not require a download or subscription fee compared with 8468 baseline non-mHealth apps. MAIN OUTCOME MEASURES: Primary outcomes were characterisation of the data collection operations in the apps code and of the data transmissions in the apps traffic; analysis of the primary recipients for each type of user data; presence of adverts and trackers in the app traffic; audit of the app privacy policy and compliance of the privacy conduct with the policy; and analysis of complaints in negative app reviews. RESULTS: 88.0% (n=18 472) of mHealth apps included code that could potentially collect user data. 3.9% (n=616) of apps transmitted user information in their traffic. Most data collection operations in apps code and data transmissions in apps traffic involved external service providers (third parties). The top 50 third parties were responsible for most of the data collection operations in app code and data transmissions in app traffic (68.0% (2140), collectively). 23.0% (724) of user data transmissions occurred on insecure communication protocols. 28.1% (5903) of apps provided no privacy policies, whereas 47.0% (1479) of user data transmissions complied with the privacy policy. 1.3% (3609) of user reviews raised concerns about privacy. CONCLUSIONS: This analysis found serious problems with privacy and inconsistent privacy practices in mHealth apps. Clinicians should be aware of these and articulate them to patients when determining the benefits and risks of mHealth apps.

Herramientas tecnológicas para el control y seguimiento de pacientes con enfermedades respiratorias y soporte de oxígeno / Technological tools for the control and follow-up of patients with respiratory diseases and oxygen support

El uso de las herramientas tecnológicas en salud permite llegar a puntos geográficos donde la medicina tradicional traza una brecha entre las instituciones de salud y los pacientes. Estas tecnologías pueden llegar a reducir las tasas de inasistencia médica, aumentar la adherencia al tratamiento y ayudar a garantizar la frecuencia apropiada de las visitas médicas. El presente trabajo se propuso realizar una revisión de la literatura sobre el control y seguimiento de pacientes con enfermedades respiratorias y soporte de oxígeno, a través de herramientas tecnológicas. Se realizó una búsqueda en las bases de datos Pubmed, Cochrane, Medline, Lilacs, Biomed, National Library, Science, con descriptores tipo Medical Subject Headings (MeSH) y Descriptores en Ciencias de la Salud (DeCS). El análisis de la literatura se realizó por medio de los elementos Strobe, Amstar. A partir de los estudios incluidos en el análisis final se puede evidenciar que la tecnología móvil en salud se ha convertido en una herramienta de gran importancia en el seguimiento y control de pacientes con enfermedades respiratorias, lo cual proporciona en tiempo real datos que pueden ser usados para minimizar complicaciones y ampliar la oportunidad de atención con calidad en pacientes con problemas respiratorios. No obstante, es necesaria la realización de ensayos clínicos que determinen los beneficios clínicos, al utilizar las herramientas tecnológicas en esta área(AU)

The use of technological tools in health allows reaching geographical points where traditional medicine draws a gap between health institutions and patients. These technologies can reduce medical absence rates, increase adherence to treatment, and help ensure the appropriate frequency of medical visits. In the present work it was proposed to carry out a review of the literature on the control and follow-up in patients with oxygen and respiratory diseases through technological tools. A search was carried out in the databases Pubmed, Cochrane, Medline, Lilacs, Biomed, National Library, Science, with descriptors such as Medical Subject Headings (MeSH) and Descriptors in Health Sciences (DeCS). The analysis of the literature was carried out using the elements Strobe, Amstar. From the studies included in the final analysis, it can be evidenced that mobile health technology has become a very important tool in the monitoring and control of patients with respiratory diseases, which provides data in real time that They can be used to minimize complications and expand the opportunity for quality care in patients with respiratory problems, however, it is necessary to carry out clinical trials to determine the clinical benefits, when using technological tools in this area(SU)

Development and Clinical Uses of a Mobile Application for Smart Wound Nursing Management.

OBJECTIVE: Establishing a smart platform for wound nursing management is imperative to accelerating the development of this specialty. A mobile application (app) was created based on the clinical needs of wound care to improve working efficiency and wound management, as well as enable information sharing and categorical retrieval of patient records. METHODS: Supported by the National Mobile Laboratory of China, the authors' wound care center collaborated with information technology engineers and user interface designers to establish a multidisciplinary team of experts in wound nursing information management and develop a digital app. Electronic tablets were chosen as a convenient clinical method to collect complete information in a standardized format. In the app, case records are synchronously cataloged for rapid retrieval. The app was designed such that practicing nurses could quickly learn how to use the various functions of the app. Through constant iterative optimization, the relevant functional modules have been further improved. RESULTS AND CONCLUSIONS: After a 1-year clinical trial, app functions have stabilized, fulfilling the expectations of technicians and boosting the operating efficiency of clinical practices. In comparison with traditional methods, the app allows for easy access to patient information; rapidly reviewed, synchronous cataloguing; and convenient retrieval. Further exploration is warranted.

Mining Google and Apple mobility data: temporal anatomy for COVID-19 social distancing.

We employ the Google and Apple mobility data to identify, quantify and classify different degrees of social distancing and characterise their imprint on the first wave of the COVID-19 pandemic in Europe and in the United States. We identify the period of enacted social distancing via Google and Apple data, independently from the political decisions. Our analysis allows us to classify different shades of social distancing measures for the first wave of the pandemic. We observe a strong decrease in the infection rate occurring two to five weeks after the onset of mobility reduction. A universal time scale emerges, after which social distancing shows its impact. We further provide an actual measure of the impact of social distancing for each region, showing that the effect amounts to a reduction by 20-40% in the infection rate in Europe and 30-70% in the US.

Do young dating app users and non-users differ in mating orientations?

In recent years, dating apps have changed the way people meet and communicate with potential romantic and/or sexual partners. There exists a stereotype considering that these apps are used only for casual sex, so those apps would not be an adequate resource to find a long-term relationship. The objective of this study was to analyze possible individual differences in the mating orientations (short-term vs. long-term) between users and non-users of dating apps. Participants were 902 single students from a mid-size Spanish university, of both sexes (63% female, and 37% male), aged between 18 and 26 years (M = 20.34, SD = 2.05), who completed a battery of online questionnaires. It was found that, whereas dating apps users had a higher short-term mating orientation than non-users (more frequent behavior, higher desire, and more positive attitude), there were no differences in the long-term orientation as a function of use/non-use. Considering this, dating apps are a resource with a strong presence of people interested on hooking-up while, simultaneously, not a bad (nor good) option for finding long-term love.

General Behavioral Engagement and Changes in Clinical and Cognitive Outcomes of Patients with Type 2 Diabetes Using the Time2Focus Mobile App for Diabetes Education: Pilot Evaluation.

BACKGROUND: Type 2 diabetes affects 30 million Americans, representing a significant cause of morbidity and mortality. Self-management support is an important component of chronic illness care and is a key pillar of the chronic care model. Face-to-face teaching and patient education materials suffer from being static or incompatible with mobile lifestyles. Digital apps provide a self-management support alternative that is convenient and scalable. OBJECTIVE: This pilot study tested the real-world deployment of a self-guided mobile app for diabetes education (Time2Focus app; MicroMass Communications Inc, Cary, NC), which utilizes evidence-based content and gamification to deliver an interactive learning experience. METHODS: Primary care providers were approached for permission to invite their patients to participate. Eligible patients were 18 to 89 years of age, had a diagnosis of type 2 diabetes, hemoglobin A1c (HbA1c) ≥8% and <12% in the past 3 months, an active online patient portal account (tied to the electronic health record), and access to an iOS or Android smartphone. Interested patients were emailed a baseline survey, and once this was completed, were sent instructions for downloading the Time2Focus app. After completing all 12 levels, participants were sent a follow-up survey. The primary outcome was the change in HbA1c. Secondary outcomes included medication adherence, self-care activities, self-reporting of physical activities, diabetes self-efficacy, illness perceptions, diabetes distress scale, and users' engagement with and rating of the app. RESULTS: Of 1355 potentially eligible patients screened, 201 were consented. Of these 201 patients, 101 (50.2%) did not download the app. Of the 100 participants (49.8%) who downloaded the app, 16 (16.0%) completed 0 levels, 26 (26.0%) completed 1 to 4 levels, 10 (10.0%) completed 5 to 11 levels, and 48 (48.0%) completed all 12 levels of the app and the follow-up survey. Those completing one or more levels had a mean pre/post-HbA1c change of -0.41% (compared to -0.32% among those who completed zero levels); however, the unadjusted two-tailed t test indicated no significant difference between the two groups (P=.73). Diabetes self-efficacy showed a large and significant increase during app usage for completers (mean change 1.28, P<.001, d=.83). Severity of illness perceptions showed a small but significant decrease during app usage for completers (mean change -0.51, P=.004, d=.43). Diabetes distress showed a small but significant decrease during app usage for completers (mean change -0.45, P=.006, d=.41). The net promoter score was 62.5, indicating that those who completed all levels of the app rated it highly and would recommend it to others. CONCLUSIONS: Participants who engaged in all 12 levels of the Time2Focus mobile app showed an improvement in diabetes self-efficacy and a decrease in severity of illness perceptions. The decrease in HbA1c observed in app users relative to nonusers during this limited pilot study was not statistically significant. However, uptake and application of lessons learned from self-management support may be delayed. Further research is needed to address how to increase engagement through self-management support and to investigate if follow up over a longer period demonstrates a significant change in outcomes such as HbA1c.

Adherence of Mobile App-Based Surveys and Comparison With Traditional Surveys: eCohort Study.

BACKGROUND: eCohort studies offer an efficient approach for data collection. However, eCohort studies are challenged by volunteer bias and low adherence. We designed an eCohort embedded in the Framingham Heart Study (eFHS) to address these challenges and to compare the digital data to traditional data collection. OBJECTIVE: The aim of this study was to evaluate adherence of the eFHS app-based surveys deployed at baseline (time of enrollment in the eCohort) and every 3 months up to 1 year, and to compare baseline digital surveys with surveys collected at the research center. METHODS: We defined adherence rates as the proportion of participants who completed at least one survey at a given 3-month period and computed adherence rates for each 3-month period. To evaluate agreement, we compared several baseline measures obtained in the eFHS app survey to those obtained at the in-person research center exam using the concordance correlation coefficient (CCC). RESULTS: Among the 1948 eFHS participants (mean age 53, SD 9 years; 57% women), we found high adherence to baseline surveys (89%) and a decrease in adherence over time (58% at 3 months, 52% at 6 months, 41% at 9 months, and 40% at 12 months). eFHS participants who returned surveys were more likely to be women (adjusted odds ratio [aOR] 1.58, 95% CI 1.18-2.11) and less likely to be smokers (aOR 0.53, 95% CI 0.32-0.90). Compared to in-person exam data, we observed moderate agreement for baseline app-based surveys of the Physical Activity Index (mean difference 2.27, CCC=0.56), and high agreement for average drinks per week (mean difference 0.54, CCC=0.82) and depressive symptoms scores (mean difference 0.03, CCC=0.77). CONCLUSIONS: We observed that eFHS participants had a high survey return at baseline and each 3-month survey period over the 12 months of follow up. We observed moderate to high agreement between digital and research center measures for several types of surveys, including physical activity, depressive symptoms, and alcohol use. Thus, this digital data collection mechanism is a promising tool to collect data related to cardiovascular disease and its risk factors.

Durability of Abstinence After Completing a Comprehensive Digital Smoking Cessation Program Incorporating a Mobile App, Breath Sensor, and Coaching: Cohort Study.

BACKGROUND: Despite decreasing prevalence over the last several decades, cigarette smoking remains the leading cause of preventable death and disease, underscoring the need for innovative, effective solutions. Pivot is a novel, inclusive smoking cessation program designed for smokers along the entire spectrum of readiness to quit. Pivot leverages proven methods and technological advancements, including a personal portable breath carbon monoxide sensor, smartphone app, and in-app text-based coaching. We previously reported outcomes from the end of active Pivot program participation in 319 adult smokers. Herein, we report longer-term follow up in this cohort. OBJECTIVE: The aim of this study was to assess and report participant outcomes 3 months after completion of Pivot, including smoking behavior, quit rates, continuous abstinence rates and durability, and predictors of abstinence. METHODS: This prospective remote cohort study included US-based cigarette smokers aged 18 to 65 years who smoked ≥5 cigarettes per day (CPD). Three months after completion of active participation in Pivot, final follow-up data were collected via an online questionnaire. Outcomes included smoking behavior (CPD and quit attempts), self-reported quit rates (7- and 30-day point prevalence abstinence [PPA]), and continuous abstinence rates (proportion who achieved uninterrupted abstinence) and duration. Exploratory regression analyses were performed to identify baseline characteristics associated with achievement of 7-day PPA, 30-day PPA, and continuous abstinence. RESULTS: A total of 319 participants completed onboarding (intention-to-treat [ITT]); 288/319 participants (90.3%) completed follow up (completers) at a mean of 7.2 (SD 1.2) months after onboarding. At final follow up, CPD were reduced by 52.6% (SE 2.1; P<.001) among all 319 participants, and most completers (152/288, 52.8%) reduced their CPD by at least 50%. Overall, most completers (232/288, 80.6%) made at least one quit attempt. Quit rates increased after the end of Pivot; using ITT analyses, 35.4% (113/319) achieved 7-day PPA and 31.3% (100/319) achieved 30-day PPA at final follow up compared with 32.0% (102/319) and 27.6% (88/319), respectively, at the end of the Pivot program. Continuous abstinence was achieved in about a quarter of those who onboarded (76/319, 23.8%) and in most who reported 30-day PPA at the end of Pivot (76/88, 86.4%), with a mean abstinence duration of 5.8 (SD 0.6) months. In exploratory regression analyses, lower baseline CPD, more positive baseline attitudes reflecting higher self-efficacy (higher confidence to quit and lower perceived difficulty of quitting), and higher education were associated with achieving abstinence. CONCLUSIONS: This study provides the first longer-term outcomes of the Pivot smoking cessation program. At final follow up, quit rates increased and continuous abstinence was favorable; the majority who achieved abstinence at the end of Pivot sustained abstinence throughout follow up. Decreases in CPD persisted and most participants made a quit attempt. Overall, final follow-up outcomes were stable or improved when compared to previous outcomes from the end of the program. These findings validate earlier results, and suggest that Pivot is an effective and durable solution for smoking cessation. TRIAL REGISTRATION: ClinicalTrials.gov NCT03295643; https://clinicaltrials.gov/ct2/show/NCT03295643.

Use of menstruation and fertility app trackers: a scoping review of the evidence.

INTRODUCTION: There has been a phenomenal worldwide increase in the development and use of mobile health applications (mHealth apps) that monitor menstruation and fertility. Critics argue that many of the apps are inaccurate and lack evidence from either clinical trials or user experience. The aim of this scoping review is to provide an overview of the research literature on mHealth apps that track menstruation and fertility. METHODS: This project followed the PRISMA Extension for Scoping Reviews. The ACM, CINAHL, Google Scholar, PubMed and Scopus databases were searched for material published between 1 January 2010 and 30 April 2019. Data summary and synthesis were used to chart and analyse the data. RESULTS: In total 654 records were reviewed. Subsequently, 135 duplicate records and 501 records that did not meet the inclusion criteria were removed. Eighteen records from 13 countries form the basis of this review. The papers reviewed cover a variety of disciplinary and methodological frameworks. Three main themes were identified: fertility and reproductive health tracking, pregnancy planning, and pregnancy prevention. CONCLUSIONS: Motivations for fertility app use are varied, overlap and change over time, although women want apps that are accurate and evidence-based regardless of whether they are tracking their fertility, planning a pregnancy or using the app as a form of contraception. There is a lack of critical debate and engagement in the development, evaluation, usage and regulation of fertility and menstruation apps. The paucity of evidence-based research and absence of fertility, health professionals and users in studies is raised.