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1.
Nat Commun ; 12(1): 232, 2021 01 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431829

RESUMO

Contact tracing is critical to controlling COVID-19, but most protocols only "forward-trace" to notify people who were recently exposed. Using a stochastic branching-process model, we find that "bidirectional" tracing to identify infector individuals and their other infectees robustly improves outbreak control. In our model, bidirectional tracing more than doubles the reduction in effective reproduction number (Reff) achieved by forward-tracing alone, while dramatically increasing resilience to low case ascertainment and test sensitivity. The greatest gains are realised by expanding the manual tracing window from 2 to 6 days pre-symptom-onset or, alternatively, by implementing high-uptake smartphone-based exposure notification; however, to achieve the performance of the former approach, the latter requires nearly all smartphones to detect exposure events. With or without exposure notification, our results suggest that implementing bidirectional tracing could dramatically improve COVID-19 control.


Assuntos
/prevenção & controle , Busca de Comunicante/métodos , Surtos de Doenças/prevenção & controle , /diagnóstico , Simulação por Computador , Humanos , Aplicativos Móveis , Sensibilidade e Especificidade , Smartphone
2.
BMJ Open Qual ; 10(1)2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33408099

RESUMO

Patients admitted to the isolation ward during the COVID-19 outbreak face multiple psychosocial stressors including the disruptive experience of being in quarantine, anxiety over contracting a newly emerging infectious disease and limited access to their healthcare team. This quality improvement project aims to leverage on technology to improve patients' access to, and experience of, care while in isolation.Patients admitted to two isolation wards in Singapore General Hospital (SGH) between 28 February and 19 March 2020 were each provided an iPad loaded with the MyCare application (app), curated materials and mobile games. During this period, 83 of them accessed the device and the app. MyCare app is an app developed by the nursing team in SGH as part of an existing interprofessional collaboration to help patients navigate their care during their inpatient stay. In response to COVID-19, MyCare app was supplemented with materials to address affected patients' informational and psychosocial needs. These materials included an information sheet on COVID-19, interviews with previous severe acute respiratory syndrome survivors, psychosocial support materials, and uplifting literature, illustrated storybooks and artwork.This paper describes the process of planning for, and executing, the intervention and reports the initial results of its effect. Initial feedback indicated a positive response to the intervention. 9 out of 10 respondents (90%) rated their hospital experience with a maximum of five stars and all 10 respondents (100%) rated the psychosocial support materials with five stars. Doctors managing the patients also observed a reduction in the number of commonly asked questions following the deployment of the iPad.This quality improvement project is ongoing with plans for further research to determine how to better support the psychosocial needs of patients in isolation during a novel disease outbreak. This report is written based on the Standards for Quality Improvement Reporting Excellence guidelines.


Assuntos
Acesso à Informação , Comportamento do Consumidor , Acesso aos Serviços de Saúde , Hospitalização , Aplicativos Móveis , Quarentena/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Surtos de Doenças , Empoderamento , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Singapura , Estresse Psicológico/etiologia , Estresse Psicológico/prevenção & controle , Adulto Jovem
3.
Rheumatology (Oxford) ; 60(1): 392-398, 2021 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-33020845

RESUMO

OBJECTIVES: To identify the changes in rheumatology service delivery across the five regions of Africa from the impact of the COVID-19 pandemic. METHODS: The COVID-19 African Rheumatology Study Group created an online survey consisting of 40 questions relating to the current practices and experiences of rheumatologists across Africa. The CHERRIES checklist for reporting results of internet e-surveys was adhered to. RESULTS: A total of 554 completed responses were received from 20 countries, which include six in Northern Africa, six in West Africa, four in Southern Africa, three in East Africa and one in Central Africa. Consultant grade rheumatologists constituted 436 (78.7%) of respondents with a mean of 14.5 ± 10.3 years of experience. A total of 77 (13.9%) rheumatologists avoided starting a new biologic. Face-to-face clinics with the use of some personal protective equipment continued to be held in only 293 (52.9%) rheumatologists' practices. Teleconsultation modalities found usage as follows: telephone in 335 (60.5%), WhatsApp in 241 (43.5%), emails in 90 (16.3%) and video calls in 53 (9.6%). Physical examinations were mostly reduced in 295 (53.3%) or done with personal protective equipment in 128 (23.1%) practices. Only 316 (57.0%) reported that the national rheumatology society in their country had produced any recommendation around COVID-19 while only 73 (13.2%) confirmed the availability of a national rheumatology COVID-19 registry in their country. CONCLUSION: COVID-19 has shifted daily rheumatology practices across Africa to more virtual consultations and regional disparities are more apparent in the availability of local protocols and registries.


Assuntos
Assistência à Saúde/métodos , Padrões de Prática Médica/estatística & dados numéricos , Reumatologistas , Adulto , África , Antirreumáticos/uso terapêutico , Produtos Biológicos/uso terapêutico , Assistência à Saúde/estatística & dados numéricos , Correio Eletrônico/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis/estatística & dados numéricos , Equipamento de Proteção Individual , Exame Físico/métodos , Guias de Prática Clínica como Assunto , Sistema de Registros/estatística & dados numéricos , Doenças Reumáticas/terapia , Reumatologia , Sociedades Médicas , Telemedicina/estatística & dados numéricos , Telefone/estatística & dados numéricos , Comunicação por Videoconferência/estatística & dados numéricos
4.
Nature ; 589(7840): 82-87, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33171481

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic markedly changed human mobility patterns, necessitating epidemiological models that can capture the effects of these changes in mobility on the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)1. Here we introduce a metapopulation susceptible-exposed-infectious-removed (SEIR) model that integrates fine-grained, dynamic mobility networks to simulate the spread of SARS-CoV-2 in ten of the largest US metropolitan areas. Our mobility networks are derived from mobile phone data and map the hourly movements of 98 million people from neighbourhoods (or census block groups) to points of interest such as restaurants and religious establishments, connecting 56,945 census block groups to 552,758 points of interest with 5.4 billion hourly edges. We show that by integrating these networks, a relatively simple SEIR model can accurately fit the real case trajectory, despite substantial changes in the behaviour of the population over time. Our model predicts that a small minority of 'superspreader' points of interest account for a large majority of the infections, and that restricting the maximum occupancy at each point of interest is more effective than uniformly reducing mobility. Our model also correctly predicts higher infection rates among disadvantaged racial and socioeconomic groups2-8 solely as the result of differences in mobility: we find that disadvantaged groups have not been able to reduce their mobility as sharply, and that the points of interest that they visit are more crowded and are therefore associated with higher risk. By capturing who is infected at which locations, our model supports detailed analyses that can inform more-effective and equitable policy responses to COVID-19.


Assuntos
/epidemiologia , Simulação por Computador , Grupos de Populações Continentais/estatística & dados numéricos , Locomoção , Fatores Socioeconômicos , /transmissão , Telefone Celular/estatística & dados numéricos , Análise de Dados , Humanos , Aplicativos Móveis/estatística & dados numéricos , Religião , Restaurantes/organização & administração , Medição de Risco , Fatores de Tempo
5.
Lancet Public Health ; 6(1): e21-e29, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33278917

RESUMO

BACKGROUND: As many countries seek to slow the spread of COVID-19 without reimposing national restrictions, it has become important to track the disease at a local level to identify areas in need of targeted intervention. METHODS: In this prospective, observational study, we did modelling using longitudinal, self-reported data from users of the COVID Symptom Study app in England between March 24, and Sept 29, 2020. Beginning on April 28, in England, the Department of Health and Social Care allocated RT-PCR tests for COVID-19 to app users who logged themselves as healthy at least once in 9 days and then reported any symptom. We calculated incidence of COVID-19 using the invited swab (RT-PCR) tests reported in the app, and we estimated prevalence using a symptom-based method (using logistic regression) and a method based on both symptoms and swab test results. We used incidence rates to estimate the effective reproduction number, R(t), modelling the system as a Poisson process and using Markov Chain Monte-Carlo. We used three datasets to validate our models: the Office for National Statistics (ONS) Community Infection Survey, the Real-time Assessment of Community Transmission (REACT-1) study, and UK Government testing data. We used geographically granular estimates to highlight regions with rapidly increasing case numbers, or hotspots. FINDINGS: From March 24 to Sept 29, 2020, a total of 2 873 726 users living in England signed up to use the app, of whom 2 842 732 (98·9%) provided valid age information and daily assessments. These users provided a total of 120 192 306 daily reports of their symptoms, and recorded the results of 169 682 invited swab tests. On a national level, our estimates of incidence and prevalence showed a similar sensitivity to changes to those reported in the ONS and REACT-1 studies. On Sept 28, 2020, we estimated an incidence of 15 841 (95% CI 14 023-17 885) daily cases, a prevalence of 0·53% (0·45-0·60), and R(t) of 1·17 (1·15-1·19) in England. On a geographically granular level, on Sept 28, 2020, we detected 15 (75%) of the 20 regions with highest incidence according to government test data. INTERPRETATION: Our method could help to detect rapid case increases in regions where government testing provision is lower. Self-reported data from mobile applications can provide an agile resource to inform policy makers during a quickly moving pandemic, serving as a complementary resource to more traditional instruments for disease surveillance. FUNDING: Zoe Global, UK Government Department of Health and Social Care, Wellcome Trust, UK Engineering and Physical Sciences Research Council, UK National Institute for Health Research, UK Medical Research Council and British Heart Foundation, Alzheimer's Society, Chronic Disease Research Foundation.


Assuntos
/epidemiologia , Aplicativos Móveis , Vigilância em Saúde Pública/métodos , Autorrelato , Adolescente , Adulto , Idoso , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
6.
Vasc Endovascular Surg ; 55(1): 18-25, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32909908

RESUMO

OBJECTIVES: We sought to develop a prediction score with data from the Vascular Quality Initiative (VQI) EVAR in efforts to assist endovascular specialists in deciding whether or not a patient is appropriate for short-stay discharge. BACKGROUND: Small series describe short-stay discharge following elective EVAR. Our study aims to quantify characteristics associated with this decision. METHODS: The VQI EVAR and NSQIP datasets were queried. Patients who underwent elective EVAR recorded in VQI, between 1/2010-5/2017 were split 2:1 into test and analytic cohorts via random number assignment. Cross-reference with the Medicare claims database confirmed all-cause mortality data. Bootstrap sampling was employed in model. Deep learning algorithms independently evaluated each dataset as a sensitivity test. RESULTS: Univariate outcomes, including 30-day survival, were statistically worse in the DD group when compared to the SD group (all P < 0.05). A prediction score, SD-EVAR, derived from the VQI EVAR dataset including pre- and intra-op variables that discriminate between SD and DD was externally validated in NSQIP (Pearson correlation coefficient = 0.79, P < 0.001); deep learning analysis concurred. This score suggests 66% of EVAR patients may be appropriate for short-stay discharge. A free smart phone app calculating short-stay discharge potential is available through QxMD Calculate https://qxcalc.app.link/vqidis. CONCLUSIONS: Selecting patients for short-stay discharge after EVAR is possible without increasing harm. The majority of infrarenal AAA patients treated with EVAR in the United States fit a risk profile consistent with short-stay discharge, representing a significant cost-savings potential to the healthcare system.


Assuntos
Aneurisma Aórtico/cirurgia , Tomada de Decisão Clínica , Técnicas de Apoio para a Decisão , Aprendizado Profundo , Procedimentos Endovasculares , Recuperação Pós-Cirúrgica Melhorada , Tempo de Internação , Alta do Paciente , Idoso , Idoso de 80 Anos ou mais , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/mortalidade , Bases de Dados Factuais , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Aplicativos Móveis , Análise Multivariada , Seleção de Pacientes , Medição de Risco , Fatores de Risco , Smartphone , Fatores de Tempo , Resultado do Tratamento
7.
Support Care Cancer ; 29(1): 301-310, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32358779

RESUMO

BACKGROUND: Children with cancer have difficulty identifying and describing the multiple symptoms they experience during hospitalization and between clinical encounters. Mobile health resources, including apps, are potential solutions to support child-centric symptom reporting. This study evaluated the feasibility and acceptability of a newly developed game-based symptom-reporting app for school-age children with cancer. PROCEDURE: Nineteen school-age children (6-12 years of age) receiving treatment for cancer at a COG institution in the Intermountain West of the United States used a game-based symptom-reporting app between clinical visits. Feasibility was evaluated through a summary of actual days of app use and interaction with each of the app's features. Children and their parents participated in interviews regarding the app's acceptability. RESULTS: Children used the app a median of 4 days (range 1-12) and interacted most frequently with the symptom reporting and the drawing features. Children enjoyed aspects of the app that supported their creativity and provided choices. Parents endorsed the interactive nature of the app and the value of the child providing his/her own report. Both children and parents identified additional opportunities to enhance the child's user experience. CONCLUSION: Study results support the preliminary feasibility and acceptability of the app. Children's and parents' responses supported the developmental relevance of the app and its role in enhancing the child's autonomy and serving as an outlet for creativity. Future directions include optimizing the child user's experience and investigating the app's role as a resource to enhance shared decision-making for symptom management.


Assuntos
Aplicativos Móveis , Neoplasias/diagnóstico , Avaliação de Sintomas/métodos , Jogos de Vídeo/estatística & dados numéricos , Criança , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pais , Telemedicina/métodos
9.
Eur Neuropsychopharmacol ; 42: 115-120, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33298386

RESUMO

The COVID-19 pandemic has led to unprecedented societal changes limiting us in our mobility and our ability to connect with others in person. These unusual but widespread changes provide a unique opportunity for studies using digital phenotyping tools. Digital phenotyping tools, such as mobile passive monitoring platforms (MPM), provide a new perspective on human behavior and hold promise to improve human behavioral research. However, there is currently little evidence that these tools can reliably detect changes in behavior. Considering the Considering the COVID-19 pandemic as a high impact common environmental factor we studied potential impact on behavior of participants using our mobile passive monitoring platform BEHAPP that was ambulatory tracking them during the COVID-19 pandemic. We pooled data from three MPM studies involving Schizophrenia (SZ), Major Depressive Disorder (MDD) and Bipolar Disorder (BD) patients (N = 12). We compared the data collected on weekdays during three weeks prior and three weeks subsequent to the start of the quarantine. We hypothesized an increase in communication and a decrease in mobility. We observed a significant increase in the total time spent on communication applications (median 179 and 243 min per week respectively, p = 0.005), and a significant decrease in the number of unique places visited (median 6 and 3 visits per week respectively, p = 0.007), while the total time spent at home did not change significantly (median 64 and 77 h per week, respectively, p = 0.594). The data provides a proof of principle that digital phenotyping tools can identify changes in human behavior incited by a common external environmental factor.


Assuntos
Transtorno Bipolar , Comunicação , Transtorno Depressivo Maior , Sistemas de Informação Geográfica , Aplicativos Móveis , Esquizofrenia , Adulto , Idoso , Comportamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Fenótipo , Estudo de Prova de Conceito , Tecnologia de Sensoriamento Remoto , Smartphone , Comportamento Espacial , Adulto Jovem
10.
Ann Otol Rhinol Laryngol ; 130(2): 125-132, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32627572

RESUMO

OBJECTIVES: Recent technological advances have led to the capability of performing high resolution imaging of the tympanic membrane. Smartphone technologies and applications have provided the opportunity to capture digital images and easily share them. The smartphone otoscope device was developed as a simple system that can convert a smartphone into a digital otoscope. This device has the prospective ability to improve physician-patient communication and assist with the diagnosis and management of ear disease. Our objective was to evaluate the feasibility and physician/parental satisfaction using the Cellscope® smartphone attachment for at home tympanostomy tube monitoring. METHODS: Children between 6 months and 15 years of age at an urban tertiary children's hospital that were scheduled for bilateral tympanostomy tube insertion or underwent bilateral tympanostomy tube surgery were prospectively enrolled in the study. Comparisons were made between parental home-recorded videos and findings during in-office otoscopy. Two independent otolaryngologists reviewed the videos and concordance between inter-rater agreements was calculated. Acceptability and use questionnaires were administered to physicians and parents. RESULTS: There was good intra-rater agreement between traditional otoscopy and video-otoscopy for tube extruding, tube blocked and tube extruded with at least 80% agreement (P < .05) and excellent inter-rater agreement between physicians for nearly all tube variables (P < .0001) There was a high degree of satisfaction with this mode of surveillance. Parents and physicians agreed that the CellScope® smartphone was easy to use, helpful with the occurrence of acute events, and appeared to improve quality of care. CONCLUSIONS: The CellScope® smartphone is feasible for use in tympanostomy tube surveillance. Use of the device may allow otolaryngologists to easily follow a child's tympanostomy tube remotely over time and offer greater parental satisfaction.


Assuntos
Ventilação da Orelha Média , Aplicativos Móveis , Otoscópios , Smartphone , Telemedicina , Gravação em Vídeo , Adolescente , Criança , Pré-Escolar , Estudos de Viabilidade , Feminino , Humanos , Lactente , Masculino , Pais , Satisfação do Paciente , Projetos Piloto , Estudos Prospectivos
12.
Ann Otol Rhinol Laryngol ; 130(1): 78-91, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32659107

RESUMO

OBJECTIVES: Although the last few years have seen an increased number of smartphone applications (apps) disseminated in the field of Otolaryngology (ORL), these apps vary widely in quality. The aim of this paper, therefore, is to systematically review ORL apps directed towards patients in mobile app stores and the current literature. METHODS: The Google Play Store, Apple App Store and PubMed were searched for ORL apps for patients using various keywords pertaining to different ORL subspecialties. Apps not relevant to the scope of this research and/or duplicates, educational apps, apps promoting a business, apps requiring specific separate hardware, and apps in non-English were excluded. In PubMed, keywords pertaining to the subspecialties were combined with "mobile app" in a search query; literature reviews, editorials, case reports, conference papers, duplicate articles, and articles irrelevant to ORL apps were excluded. The quality of apps with the highest number of reviews was assessed using the "Mobile App Rating Scale" (MARS), while the quality of the articles was rated using "The Strengthening the Reporting of Observational Studies in Epidemiology" (STROBE) Statement. RESULTS: After searching the app stores, 1074 apps were included and grouped according to their ORL subspecialties. The overall MARS score of the ten most popular apps in each category was 3.65 out of 5. A total of 636 articles were identified in the literature, and 193 were included. The mean adherence percentage of the articles to the STROBE checklist was of 84.37%. CONCLUSIONS: Although the apps currently available need further development, their application in ORL appears promising. Further dialogue between physicians and patients, as well as formal support from professional and scientific associations, should be encouraged.


Assuntos
Aplicativos Móveis/estatística & dados numéricos , Otolaringologia , Smartphone , Humanos
13.
Int J Clin Pract ; 75(1)2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32946641

RESUMO

BACKGROUND: At the end of 2019, a novel coronavirus (COVID-19) was identified in China. The high potential of human-to-human transmission led to subsequent COVID-19 global pandemic. Public health strategies including reduced social contact and lockdown have been adopted in many countries. Nonetheless, social distancing and isolation could also represent risk factors for mental disorders, resulting in loneliness, reduced social support and under-detection of mental health needs. Along with this, social distancing determines a relevant obstacle for direct access to psychiatric care services. The pandemic generates the urgent need for integrating technology into innovative models of mental healthcare. AIMS: In this paper, we discuss the potential role of telepsychiatry (TP) and other cutting-edge technologies in the management of mental health assistance. We narratively review the literature to examine the advantages and risks related to the extensive application of these new therapeutic settings, along with the possible limitations and ethical concerns. RESULTS: Telemental health services may be particularly feasible and appropriate for the support of patients, family members and healthcare providers during this COVID-19 pandemic. The integration of TP with other technological innovations (eg, mobile apps, virtual reality, big data and artificial intelligence (AI)) opens up interesting future perspectives for the improvement of mental health assistance. CONCLUSION: Telepsychiatry is a promising and growing way to deliver mental health services but is still underused. The COVID-19 pandemic may serve as an opportunity to introduce and promote, among numerous mental health professionals, the knowledge of the possibilities offered by the digital era.


Assuntos
/psicologia , Transtornos Mentais/terapia , Psiquiatria/métodos , Psicoterapia/métodos , Telemedicina , Inteligência Artificial , Assistência à Saúde/métodos , Família/psicologia , Pessoal de Saúde/psicologia , Humanos , Transtornos Mentais/virologia , Serviços de Saúde Mental/ética , Aplicativos Móveis , Privacidade , Telemedicina/ética , Realidade Virtual
14.
PLoS One ; 15(12): e0242652, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33362218

RESUMO

OBJECTIVE: To study the U.S. public's attitudes toward surveillance measures aimed at curbing the spread of COVID-19, particularly smartphone applications (apps) that supplement traditional contact tracing. METHOD: We deployed a survey of approximately 2,000 American adults to measure support for nine COVID-19 surveillance measures. We assessed attitudes toward contact tracing apps by manipulating six different attributes of a hypothetical app through a conjoint analysis experiment. RESULTS: A smaller percentage of respondents support the government encouraging everyone to download and use contact tracing apps (42%) compared with other surveillance measures such as enforcing temperature checks (62%), expanding traditional contact tracing (57%), carrying out centralized quarantine (49%), deploying electronic device monitoring (44%), or implementing immunity passes (44%). Despite partisan differences on a range of surveillance measures, support for the government encouraging digital contact tracing is indistinguishable between Democrats (47%) and Republicans (46%), although more Republicans oppose the policy (39%) compared to Democrats (27%). Of the app features we tested in our conjoint analysis experiment, only one had statistically significant effects on the self-reported likelihood of downloading the app: decentralized data architecture increased the likelihood by 5.4 percentage points. CONCLUSION: Support for public health surveillance policies to curb the spread of COVID-19 is relatively low in the U.S. Contact tracing apps that use decentralized data storage, compared with those that use centralized data storage, are more accepted by the public. While respondents' support for expanding traditional contact tracing is greater than their support for the government encouraging the public to download and use contact tracing apps, there are smaller partisan differences in support for the latter policy.


Assuntos
/epidemiologia , Busca de Comunicante/ética , Pandemias , Quarentena/psicologia , Adulto , /virologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis , Percepção , Privacidade , Vigilância em Saúde Pública , Smartphone , Inquéritos e Questionários , Estados Unidos
15.
Medicine (Baltimore) ; 99(52): e23624, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33350739

RESUMO

INTRODUCTION: Female farmers commonly experience musculoskeletal pain in the back, knee, and shoulder. Despite their obvious advantages in reducing musculoskeletal pain, face-to-face exercise programs are limited by geographical and physical barriers. Thus, we decided to introduce eHealth technology to farmers' musculoskeletal health care. Using a mobile application (app), we aim to provide a tailored self-exercise program for shoulder, knee, and back pain in female farmers in rural areas after a musculoskeletal health check-up. METHODS: This study is planned as 2 randomized control studies (MObile Delivered self-Exercise [MODE] phase I and phase II). We plan to recruit 200 female farmers aged 41 to 70 years. Initially, the shoulders, knees, and low back will be evaluated to provide individualized exercise programs. In MODE-I (single-blinded: evaluator), the subjects will be randomly allocated to experimental (n = 100) and control (n = 100) groups using a computer-generated sequence. Both groups will perform a 3-month self-exercise using a smartphone app or physical education data (booklets), respectively. Outcomes including exercise completion will be assessed at 3 months. In MODE-II, after subject random allocation, the experimental and control groups will perform exercise using a smartphone app with and without real-time feedback, respectively. Every 3 months, the level of the exercise program will be evaluated and the difficulty level will be adapted accordingly. After MODE-II is completed, all subjects will undergo close-out assessment. DISCUSSION: This will be the first attempt to compare methods using booklets and apps to identify effective ways of providing personalized self-exercise programs according to musculoskeletal health stages by evaluating female farmers (MODE-I). This will help clarify whether the mobile app is effective for self-exercise compared to a conventional booklet. The MODE-II study will help to assess the effect of providing feedback through the mobile app. Finally, we will evaluate musculoskeletal health according to the degree of participation over 12 months to confirm the effect of self-exercise. Our study should aid in managing musculoskeletal health for farmers living in rural areas and help promote health in the "untact" era. TRIAL REGISTRATION: Clinical Research Information Service of the Korean National Institutes of Health (KCT0005245). Registered July 17, 2020.


Assuntos
Doenças dos Trabalhadores Agrícolas/terapia , Terapia por Exercício/métodos , Aplicativos Móveis , Dor Musculoesquelética/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Autocuidado/métodos , Telemedicina/métodos , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Método Simples-Cego
16.
ACS Nano ; 14(12): 16180-16193, 2020 12 22.
Artigo em Inglês | MEDLINE | ID: mdl-33314910

RESUMO

The management of the COVID-19 pandemic has relied on cautious contact tracing, quarantine, and sterilization protocols while we await a vaccine to be made widely available. Telemedicine or mobile health (mHealth) is well-positioned during this time to reduce potential disease spread and prevent overloading of the healthcare system through at-home COVID-19 screening, diagnosis, and monitoring. With the rise of mass-fabricated electronics for wearable and portable sensors, emerging telemedicine tools have been developed to address shortcomings in COVID-19 diagnostics, monitoring, and management. In this Perspective, we summarize current implementations of mHealth sensors for COVID-19, highlight recent technological advances, and provide an overview on how these tools may be utilized to better control the COVID-19 pandemic.


Assuntos
/métodos , /terapia , Gerenciamento Clínico , Telemedicina/métodos , Antígenos Virais/análise , Técnicas Biossensoriais/instrumentação , /virologia , Busca de Comunicante/instrumentação , Humanos , Aplicativos Móveis/provisão & distribução , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/métodos , Nanotecnologia/instrumentação , Nanotecnologia/métodos , Sistemas Automatizados de Assistência Junto ao Leito/organização & administração , Testes Imediatos/organização & administração , Quarentena/organização & administração , Telemedicina/instrumentação
18.
Nephrol Nurs J ; 47(6): 529-536, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33377753

RESUMO

Despite the increasing number of consumer-based mobile health applications (mHealth apps) for self-care, there is little research exploring consumers' experiences with mHealth apps. Health apps using mobile technology have the potential to provide a platform for kidney transplant recipients to monitor their self-care in real time. This study explored kidney transplant recipients' perceptions of the usefulness of mHealth apps and identified features that Kidney transplant recipients believe are important for using mHealth apps. A qualitative design was used to explore a purposive sample of adult kidney transplant recipients from a Midwest Transplant Program who used an mHealth app. Qualitative content data analysis revealed three themes participants found useful: health tracking (medication, nutrition, fluid intake, lab values, and activity), feedback (short personalized messages, positive awards using symbols, and color-coded bar graphs indicating normal and abnormal ranges), and usability (large font, words that everyone can understand, and all information stored in one area).


Assuntos
Telefone Celular , Transplante de Rim , Aplicativos Móveis , Autocuidado , Telemedicina/métodos , Adulto , Humanos , Entrevistas como Assunto , Monitorização Fisiológica , Pesquisa Qualitativa , Telemedicina/instrumentação
19.
J Med Internet Res ; 22(12): e24268, 2020 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-33264099

RESUMO

BACKGROUND: The COVID-19 crisis and consequent confinement restrictions have caused significant psychosocial stress and reports of sleep complaints, which require early management, have increased during recent months. To help individuals concerned about their sleep, we developed a smartphone-based app called KANOPEE that allows users to interact with a virtual agent dedicated to autonomous screening and delivering digital behavioral interventions. OBJECTIVE: Our objective was to assess the feasibility of this app, in terms of inclusion rate, follow-up rate, perceived trust and acceptance of the virtual agent, and effects of the intervention program, in the context of COVID-19 confinement in France. METHODS: The virtual agent is an artificial intelligence program using decision tree architecture and interacting through natural body motion and natural voice. A total of 2069 users aged 18 years and above downloaded the free app during the study period (April 22 to May 5, 2020). These users first completed a screening interview based on the Insomnia Severity Index (ISI) conducted by the virtual agent. If the users were positive for insomnia complaints (ISI score >14), they were eligible to join the 2-stage intervention program: (1) complete an electronic sleep diary for 1 week and (2) follow personalized sleep recommendations for 10 days. We collected and analyzed the following measures: sociodemographic information, ISI scores and sleep/wake schedules, and acceptance and trust of the agent. RESULTS: Approximately 76% (1574/2069) of the app users completed the screening interview with the virtual agent. The virtual agent was well accepted by 27.4% (431/1574) of the users who answered the acceptance and trust questionnaires on its usability, satisfaction, benevolence, and credibility. Of the 773 screened users who reported sleep complaints (ISI score >14), 166 (21.5%) followed Step 1 of the intervention, and only 47 of those (28.3%) followed Step 2. Users who completed Step 1 found that their insomnia complaints (baseline mean ISI score 18.56, mean ISI score after Step 1 15.99; P<.001) and nocturnal sleep quality improved significantly after 1 week. Users who completed Step 2 also showed an improvement compared to the initial measures (baseline mean ISI score 18.87, mean ISI score after Step 2 14.68; P<.001). Users that were most severely affected (ISI score >21) did not respond to either intervention. CONCLUSIONS: These preliminary results suggest that the KANOPEE app is a promising solution to screen populations for sleep complaints and that it provides acceptable and practical behavioral advice for individuals reporting moderately severe insomnia.


Assuntos
/epidemiologia , Terapia Cognitivo-Comportamental/métodos , Distúrbios do Início e da Manutenção do Sono/terapia , Smartphone , Isolamento Social/psicologia , Adolescente , Adulto , Idoso , Inteligência Artificial , Árvores de Decisões , Estudos de Viabilidade , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis , Estudo de Prova de Conceito , Quarentena , Sono , Estresse Psicológico/complicações , Inquéritos e Questionários , Telemedicina , Adulto Jovem
20.
JMIR Mhealth Uhealth ; 8(12): e24693, 2020 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-33301415

RESUMO

BACKGROUND: Adults with chronic conditions are disproportionately burdened by COVID-19 morbidity and mortality. Although COVID-19 mobile health (mHealth) apps have emerged, research on attitudes toward using COVID-19 mHealth tools among those with chronic conditions is scarce. OBJECTIVE: This study aimed to examine attitudes toward COVID-19, identify determinants of COVID-19 mHealth tool use across demographic and health-related characteristics, and evaluate associations between chronic health conditions and attitudes toward using COVID-19 mHealth tools (eg, mHealth or web-based methods for tracking COVID-19 exposures, symptoms, and recommendations). METHODS: We used nationally representative data from the COVID-19 Impact Survey collected from April to June 2020 (n=10,760). Primary exposure was a history of chronic conditions, which were defined as self-reported diagnoses of cardiometabolic, respiratory, immune-related, and mental health conditions and overweight/obesity. Primary outcomes were attitudes toward COVID-19 mHealth tools, including the likelihood of using (1) a mobile phone app to track COVID-19 symptoms and receive recommendations; (2) a website to track COVID-19 symptoms, track location, and receive recommendations; and (3) an app using location data to track potential COVID-19 exposure. Outcome response options for COVID-19 mHealth tool use were extremely/very likely, moderately likely, or not too likely/not likely at all. Multinomial logistic regression was used to compare the likelihood of COVID-19 mHealth tool use between people with different chronic health conditions, with not too likely/not likely at all responses used as the reference category for each outcome. We evaluated the determinants of each COVID-19 mHealth intervention using Poisson regression. RESULTS: Of the 10,760 respondents, 21.8% of respondents were extremely/very likely to use a mobile phone app or a website to track their COVID-19 symptoms and receive recommendations. Additionally, 24.1% of respondents were extremely/very likely to use a mobile phone app to track their location and receive push notifications about whether they have been exposed to COVID-19. After adjusting for age, race/ethnicity, sex, socioeconomic status, and residence, adults with mental health conditions were the most likely to report being extremely/very or moderately likely to use each mHealth intervention compared to those without such conditions. Adults with respiratory-related chronic diseases were extremely/very (conditional odds ratio 1.16, 95% CI 1.00-1.35) and moderately likely (conditional odds ratio 1.23, 95% CI 1.04-1.45) to use a mobile phone app to track their location and receive push notifications about whether they have been exposed to COVID-19. CONCLUSIONS: Our study demonstrates that attitudes toward using COVID-19 mHealth tools vary widely across modalities (eg, web-based method vs app) and chronic health conditions. These findings may inform the adoption of long-term engagement with COVID-19 apps, which is crucial for determining their potential in reducing disparities in COVID-19 morbidity and mortality among individuals with chronic health conditions.


Assuntos
/prevenção & controle , Doença Crônica/terapia , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Aplicativos Móveis/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Adolescente , Adulto , Doença Crônica/psicologia , Feminino , Pesquisas sobre Serviços de Saúde/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Telemedicina/métodos , Adulto Jovem
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