Association between glucose levels of children with type 1 diabetes and parental economic status in mobile health application

BACKGROUND The glycemic control of children with type 1 diabetes(T1D)may be influenced by the economic status of their parents.AIM To investigate the association between parental economic status and blood glucose levels of children with T1D using a mobile health application.METHODS Data from children with T1D in China's largest T1D online community,Tang-TangQuan■.Blood glucose levels were uploaded every three months and parental economic status was evaluated based on annual household income.Children were divided into three groups:Low-income(<30000 Yuan),middle-income(30000-100000 Yuan),and high-income(>100000 yuan)(1 Yuan=0.145 United States Dollar approximately).Blood glucose levels were compared among the groups and associations were explored using Spearman’s correlation analysis and multivariable logistic regression.RESULTS From September 2015 to August 2022,1406 eligible children with T1D were included(779 female,55.4%).Median age was 8.1 years(Q1-Q3:4.6-11.6)and duration of T1D was 0.06 years(0.02-0.44).Participants were divided into three groups:Low-income(n=320),middle-income(n=724),and high-income(n=362).Baseline hemoglobin A1c(HbA1c)levels were comparable among the three groups(P=0.072).However,at month 36,the low-income group had the highest HbA1c levels(P=0.036).Within three years after registration,glucose levels increased significantly in the low-income group but not in the middle-income and high-income groups.Parental economic status was negatively correlated with pre-dinner glucose(r=-0.272,P=0.012).After adjustment for confounders,parental economic status remained a significant factor related to pre-dinner glucose levels(odds ratio=13.02,95%CI:1.99 to 126.05,P=0.002).CONCLUSION The blood glucose levels of children with T1D were negatively associated with parental economic status.It is suggested that parental economic status should be taken into consideration in the management of T1D for children.

Impact of mobile health and medical applications on clinical practice in gastroenterology

Mobile health apps (MHAs) and medical apps (MAs) are becoming increasinglypopular as digital interventions in a wide range of health-related applications inalmost all sectors of healthcare. The surge in demand for digital medical solutionshas been accelerated by the need for new diagnostic and therapeutic methods inthe current coronavirus disease 2019 pandemic. This also applies to clinicalpractice in gastroenterology, which has, in many respects, undergone a recentdigital transformation with numerous consequences that will impact patients andhealth care professionals in the near future. MHAs and MAs are considered tohave great potential, especially for chronic diseases, as they can support the selfmanagementof patients in many ways. Despite the great potential associated withthe application of MHAs and MAs in gastroenterology and health care in general,there are numerous challenges to be met in the future, including both the ethicaland legal aspects of applying this technology. The aim of this article is to providean overview of the current status of MHA and MA use in the field ofgastroenterology, describe the future perspectives in this field and point out someof the challenges that need to be addressed.

A systematic review of the effect of mobile health on cardiac rehabilitation among coronary heart disease patients

Objective： Mobile health （mHealth） provides an innovative and effective approach to promote prevention and management of coronary heart disease. However, the magnitude of its effects is unclear. The aim of this systematic review was to examine the impact of mHealth-based cardiac rehabilitation outcomes among coronary heart disease patients. Methods： Medline, CINAHL, Embase, PubMed, Google Scholar, NICE, and Cochrane library were searched for randomized controlled trials published between January 2002 and March 2017 which compared mHealth with conventional cardiac rehabilitation programs among coronary heart disease patients. Results： Eight articles were included in this review. The impact of mHealth interventions on physical activity, medicine adherence, smoking cessation, level of anxiety, and quality of life was inconsistent among the articles. Conclusions： Further research is needed to conclusively determine the impact of mHealth interventions on cardiac rehabilitation outcomes. The limitations of the included studies （e.g., inadequate sample size, failure to address the core components of cardiac rehabilitation programs, and lack of theory-based design） should be taken into account when designing future studies.

Mobile health:new technologies,new modes and new era

In the past decade, tremendous developments have been made in mobile communicating technologies, such as fourth generation communication, satellite communication, and wireless network, which, when combined with healthcare, promoted the development of mobile health （mhealth）. Mobile health is defined by the Healthcare Information and Management Systems Society （HIMSS） as the use of small, portable com- puters or telecommunication equipments to meet the needs of consumers for health care or health infor- mation services. It is a combination of the biomedical sensor technology, mobile computing technology and networking technology. The surge in mobile commu- nication technologies has transformed the mode and quality of clinical research and healthcare on a global scale. Consequently, mhealth is the new edge on health- care innovation and heralds the arrival of new era of healthcare.

AB030.Usability of ArtontheBrain:A visual-arts based mobile health solution to promote quality of life in older adults with low vision due to age-related macular degeneration

Background:Taking part in productive and enjoyable recreational activities has been shown improve quality of life for people of all ages and capabilities.However,vision loss can have a significant impact on participation in important leisure activities.This is especially the case for the elderly,whose lowered mobility is further impacted by vision loss.Technology can offer solutions to bridging some barriers caused by these deficits by bringing leisure activities to the user in the form of mobile applications.As such,the purpose of the present study was to evaluate the accessibility and usability of the ArtOnTheBrain application,a visual art based mobile health solution to promote brain health and well-being,by older adults with low vision due to age-related macular degeneration(AMD).Methods:There were a total of 16 participants(age range,65-93 years,M=79,10 males).All had a diagnosis of AMD with visual acuities in the better eye between 20/60 and 20/200.Additionally,all participants had accessed rehabilitation services and most had experience using a computer at home.Using an Apple iPad Air(2013),they were asked to interact with the ArtOnTheBrain website’s Learn(e.g.,Listen to artwork description)and Play(e.g.,complete a word-search game)features with either the Safari or Google Chrome Internet apps.Using the Concurrent Think Aloud method,participants were asked to continuously comment on their activities and experiences with the app and verbalize their internal monologue while being audio and video recorded.These recordings were later transcribed verbatim and analysed using qualitative description and thematic analysis.Results:Participants’behaviours and verbal feedback were divided based on whether they presented as barriers or facilitators.Beginning with barriers,these were mostly related to the accessibility of the visual aspects of the applications interface(i.e.,contrast and font size),whereby participants requested additional control over the magnification options,both for text as well as images of the artwork.The main facilitator was the audio option built into the Learn tab,which allowed participants to listen to the artwork descriptions.Facilitators also included the aesthetics of the app,the perceived boost in confidence in interacting with technology,and the educational and leisure benefits.Conclusions:Older adults with low vision are faced with a decreased ability to engage in leisure activities.The development of technologies aimed at increasing the accessibility of leisure activities for these individuals is an important step in increasing their quality of life.As such,despite some of the accessibility challenges,the majority of participants viewed ArtontheBrain positively.Identifying the barriers and facilitators to its use is an important step in the development of this application in order to optimize its accessibility for older adults with low vision.Future work to be done with this application will be to evaluate the cognitive impact of ArtontheBrain on low vision users.

Internet-based nationwide evaluation of patient preferences for mobile health features in ankylosing spondylitis

Background Ankylosing spondylitis(AS)generally occurs in young adults.The functional impairments resulting in limitation in activities and social participation might exert lifetime impacts.The present study investigated the preferences for mobile health(mHealth)features motivating the self-management behaviors in AS.Methods The present study was an internet-based,nationwide quantitative study based on the Chinese Ankylos-ing Spondylitis Prospective Imaging Cohort(CASPIC)study,which was a nationwide,ongoing,prospective cohort study launched in conjunction with Smart-phone SpondyloArthritis Management System(SpAMS)in China.Par-ticipants with AS from the CASPIC were invited to report their mHealth preferences from December 2019 to February 2020.The questionnaire was designed to determine the patient preferences for 28 mHealth features.Sociodemographic characteristics,including age,gender,and work status,were collected.Results Among all the visitors to the online questionnaire(n=872),93.9%(819/872)respondents fully com-pleted the questionnaire and were enrolled in the present study.The mean age was(33.4±9.0)years,and 70.57%(578/819)of the respondents were males.The mean scores of 22(78.57%)features were greater than 4(like or strongly like).The mean standard deviation(SD)score of exercise instructions was 4.70(0.63),which was the most preferred feature,whereas the social interaction features were preferred the least.Pain analysis was more preferred among female respondents(4.72 vs.4.60,P=0.012),whereas all items of the social interaction theme and social interaction as a whole(3.73 vs.3.52,P<0.001)were less preferred among female respondents.Additionally,the following themes were more preferred by respondents aged≤40 years:credibility and styling(4.37 vs.4.19,P<0.001);disease action support(4.55 vs.4.47,P=0.007);and incentivization(4.35 vs.4.24,P=0.025).Conclusion AS patients show great interest for the majority of mHealth features.Exercise instructions and exercise scheduling are the most preferred features,whereas social interaction is the least preferred feature.In addition,gender-related and age-related differences exist in mHealth feature preferences.

Plasmonic molecular assays： Recent advances and applications for mobile health

Plasmonics-based biosensing assays have been extensively employed for biomedical applications. Significant advancements in use of plasmonic assays for the construction of point-of-care （POC） diagnostic methods have been made to provide effective and urgent health care of patients, especially in resource- limited settings. This rapidly progressive research area, centered on the unique surface plasmon resonance （SPR） properties of metallic nanostructures with exceptional absorption and scattering abilities, has greatly facilitated the development of cost-effective, sensitive, and rapid strategies for disease diagnostics and improving patient healthcare in both developed and developing worlds. This review highlights the recent advances and applications of plasmonic technologies for highly sensitive protein and nucleic acid biomarker detection. In particular, we focus on the implementation and penetration of various plasmonic technologies in conventional molecular diagnostic assays, and discuss how such modification has resulted in simpler, faster, and more sensitive alternatives that are suited for point-of-use. Finally, integration of plasmonic molecular assays with various portable POC platforms for mobile health applications are highlighted.

Mobile technology for health care in rural China

With the proliferation of mobile technologies in China,the Chinese mobile medical applications market is growing rapidly.This may be particularly useful for Chinese rural populations who have limited access to quality medical care where mobile technologies can reach across geographic and socioeconomic boundaries and potentially increase access to care and improve health outcomes.

Mobile health technology: a novel tool in chronic disease management

The successful control of chronic diseases mainly depends on how well patients manage their disease conditions with the aid of healthcare providers.Mobile health technology—also known as mHealth—supports healthcare practice by means of mobile devices such as smartphone applications,web-based technologies,telecommunications services,social media,and wearable technology,and is becoming increasingly popular.Many studies have evaluated the utility of mHealth as a tool to improve chronic disease management through monitoring and feedback,educational and lifestyle interventions,clinical decision support,medication adherence,risk screening,and rehabilitation support.The aim of this article is to summarize systematic reviews addressing the effect of mHealth on the outcome of patients with chronic diseases.We describe the current applications of various mHealth approaches,evaluate their effectiveness as well as limitations,and discuss potential challenges in their future development.The evidence to date indicates that none of the existing mHealth technologies are inferior to traditional care.Telehealth and web-based technologies are the most frequently reported interventions,with promising results ranging from alleviation of disease-related symptoms,improvement in medication adherence,and decreased rates of rehospitalization and mortality.The new generation of mHealth devices based on various technologies are likely to provide more efficient and personalized healthcare programs for patients.

Receiving antenatal care via mobile clinic: Lived experiences of Jordanian mothers

Objective To understand the perceptions of pregnant Jordanian women who received antenatal care via mobile clinic,and to contribute new insights into the experiences of these mothers and how they evaluated the services that were available.Methods Ten Jordanian mothers who had received antenatal care at a mobile clinic discussed their experiences in semi-structured,audiotaped interviews in a study that adopted a qualitative research design.The analysis was done using interpretative phenomenological analysis.Results Three main themes were identified:Being informed about the medical campaign or missing the opportunity of being informed;The experience of receiving antenatal care was wonderful,although there was only one thing lacking;and they safeguard our life and take any opportunity to educate us.Conclusion Data indicate that the mothers were largely satisfied with most facets of the antenatal care services they had received at the mobile clinics.However,while services are generally well received,there are clear opportunities for ameliorating the quality of services provided.For mothers living in remote,deprived areas,outreach is not just an‘optional extra’but rather an essential service.

Economic Evaluation of Mobile Mental Health Units in Greece: The Case of Cyclades Islands

Background: In Greece, the provision of mental health services is limited to people residing in rural and remote areas. The operation of Mobile Mental Health Units (MMHUs) has been introduced in the Cyclades islands. It is an innovative policy intervention that has been shown to be effective and efficient internationally. Objective: The aim was to evaluate the operation of MMHUs in the Cyclades islands based on real-world evidence (RWE), from a societal perspective. Methods: A cost-effectiveness analysis was performed where outcomes and costs were elaborated and classified based on two comparators, 1) with MMHUs’ operation and 2) without MMHUs’ operation. Clinical primary outcomes were based on RWE data and were elaborated for the Disability-Adjusted Life Years (DALYs) values calculation, for a 12 months’ time horizon. Data descriptive statistics were performed with SPSS Statistics 22.0. Direct medical, non-medical and indirect costs were incorporated. Unit costs and monetary values were extracted from published data. Sensitivity analysis was undertaken to test the robustness of the results. Results: The operation of MMHUs in the Cyclades islands led to an incremental cost of €12,250.78 per DALY averted. A substantial higher increase is observed in the direct non-medical costs of the non-MMHUs’ operation where patients had to pay approximately €2,602 per capita annually for their transportation and accommodation due to hospitalization and outpatient care. Informal care expenses are 3 fold increasing in the non-MMHUs’ operation arm. Both direct non-medical and informal care costs correspond to high out of pocket payments totally covered by the patients. The sensitivity analyses demonstrated that the decision does not change when we varied the unit costs by ±10%. Conclusions: The operation of MMHUs appears to be a cost-effective option for treating patients with mental disorders in remote areas and islands in Greece. MMHUs appear to overcome the existing NHS structural inefficiencies by minimizing public expenditures and patients’ income losses by preventing and improving their mental health status.

Validating the CorrectWearing of Protection Mask by Taking a Selfie:Design of a Mobile Application“CheckYourMask”to Limit the Spread of COVID-19

In a context of a virus that is transmissive by sputtering,wearing masks appear necessary to protect the wearer and to limit the propagation of the disease.Currently,we are facing the 2019-2020 coronavirus pandemic.Coronavirus disease 2019(COVID-19)is an infectious disease with first symptoms similar to the flu.The symptom of COVID-19 was reported first in China and very quickly spreads to the rest of the world.The COVID-19 contagiousness is known to be high by comparison with the flu.In this paper,we propose a design of a mobile application for permitting everyone having a smartphone and being able to take a picture to verify that his/her protection mask is correctly positioned on his/her face.Such application can be particularly useful for people using face protection mask for the first time and notably for children and old people.The designed method exploits Haar-like feature descriptors to detect key features of the face and a decision-making algorithm is applied.Experimental results show the potential of this method in the validation of the correct mask wearing.To the best of our knowledge,our work is the only one that currently proposes a mobile application design“CheckYourMask”for validating the correct wearing of protection mask.

Nursing and mHealth

Innovations in mobile health(mHealth)technology offer applications to promote wellness management and health behavior change outside of formal clinical settings.Nurses can help to move mHealth into mainstream health care by understanding its potential to change the landscape of health intervention delivery,incorporating mHealth into patients'day to day preventive care strategies,and supporting the science of mHealth's effectiveness.

Mobile medical applications’state quo and underlying barriers:review of literature

Objective:To explore the current development and challenges regarding mobile medical applications(mmAPPs),so as to provide reference for application function elevation and quality improvement.Methods:We retrieved literature databases like Web of Science,PubMed,China National Knowledge Infrastructure,Wanfang,China Biomedical Network,time limit was from January 1,2010 to December 31,2021,and restricted to the Chinese or English language.Results:This study concluded with the following six aspects:Domestic and foreign development of mmAPP,reminder function,barriers and challenges(low quality;slow update rate;lack of standard evaluation tool or criterion),privacy and safety concerns,adverse drug event report state(low report rate-related reasons,different countries’report policies),and current hindrances in the progression(economic worries;personal education level;acceptance and study of technology;rural districts,and low-income countries).Conclusions:We should focus on the application’s quality elevation rather than quantity,pay more attention to patients’adverse drug event reports,privacy and safety,and place emphasis on rural districts and low-income countries.

Collaborating with Young Adults Diagnosed with Schizophrenia:A Participatory Design Study to Shape the Healthcare System

Introduction: Disengagement from mental health services in young adults with schizophrenia has been associated with dissatisfaction and unmet needs. Striving to improve engagement, we invited service users recently diagnosed with schizophrenia to be co-designers of a smartphone technology that will be responsive to their needs. Aim: This paper reports the first phase of a three-phased participatory design process. The objective was to identify needs of support in young adults recently diagnosed with schizophrenia and to generate ideas of how the needs could be accommodated using smartphone technology. Methods: Participatory design guided the research process and a qualitative approach was used to generate and analyse the data. Data were generated by means of participant observations (n = 45 hours) and interviews (n = 6) with young adults from a first episode psychosis program in Denmark. Findings: Low levels of knowledge and high levels of uncertainties are characteristic of young adults recently diagnosed with schizophrenia, bringing about a vast need of support in order for them to gain power over their new life situation. Our study suggests that the smartphone may be used to foster empowerment by guiding the young adult’s actions in situ, providing comprehensive and easily understood information on the go, allowing for recovery tracking, and notification of mental health changes, providing medication overview and giving easy access to healthcare providers. Conclusion: Young adults recently diagnosed with schizophrenia require comprehensive support in order to become empowered to confidently manage their new life situation. The smartphone holds this potential by offering flexible collaboration and timely access to self-management

基于SWOT-CLPV分析的上海市老年人移动医疗服务利用现状及策略研究

目的了解上海市老年人移动医疗服务利用现状,为解决老年人“数字鸿沟”问题提出相应策略。方法对上海市461名老年人进行问卷调查,了解其知晓和利用移动医疗服务的现状,在此基础上采用SWOT-CLPV[优势(strengths),劣势(weaknesses),机会(opportunities),威胁(threats)-抑制性(control),杠杆作用(leverage),问题性(problem),脆弱性(vulnerability)]分析法进一步分析老年人利用移动医疗服务的优势、劣势、机会和威胁并找出主要的影响因素。结果知晓移动医疗服务的老年人比例为79.61%,其中每次就医都使用的仅有2.72%,能够独立使用的只有27.76%,总体上,老年人移动医疗服务利用现状不理想。SWOT-CLPV分析显示,老年人利用移动医疗服务的主要劣势是老年人自身条件以及使用基础和移动医疗功能受限,主要威胁是老年群体需求受到外界忽略。结论目前老年人对移动医疗服务的了解和利用并不充分,需加强家庭和社会对老年人利用移动医疗服务的支持,建立强有力的法律法规以提高数字化技术的适老化。

基于结构方程模型的老年人移动医疗服务使用意愿影响因素及路径分析:以上海市为例

目的 了解上海市老年人移动医疗服务使用意愿的影响因素,为制定有针对性的干预策略提供依据。方法对上海市406名老年人进行问卷调查,运用SPSS 26.0和AMOS 26.0进行描述统计、单因素秩和检验、相关分析和结构方程模型检验。结果 上海市老年人移动医疗服务使用意愿得分为(3.72±0.87)分。不同年龄段、文化程度、职业、收入水平和居住方式老年人的使用意愿差异分别有统计学意义(P <0.05)。社会影响、绩效期望、便利条件、努力期望和健康态度会对使用意愿产生直接或间接的正向影响,总效应分别为0.246、0.330、0.633、0.160和0.093。抵触改变和技术焦虑对使用意愿有间接的负向影响,总效应分别为-0.043和-0.054。各路径间的效应均有统计学意义(P <0.05)。结论 上海市老年人移动医疗服务使用意愿有待提升,应重点关注使用意愿较低的群体,从各维度影响因素入手提高老年人的使用意愿。

Assessment of a Downloadable Application with Avatar Guidance for PT-Prescribed Home Exercise after Total Knee Arthroplasty: A 30-Day Usability and Feasibility Study

Objective: To explore the usability and feasibility of a downloadable application (APP) compared to paper handouts (CONTROL) in guiding 30 days of PT-prescribed home exercise after total knee arthroplasty (TKA), and to compare functional outcomes at 30 days postoperatively between APP and CONTROL. Design: Randomized controlled usability and feasibility study. Setting: Rehabilitation laboratories at two regional medical centers. Participants: Individuals with knee osteoarthritis undergoing unilateral TKA (APP group: N = 26;mean age, 67.0 ± 8.2 y;CONTROL group: N = 31;mean age, 64.7 ± 7.7 y). Interventions: This study assessed the user experience of a downloadable app to guide 30 days of home exercises and instruction after TKA and compared exploratory outcomes to a group using paper handouts. Main Outcome Measures: The System Usability Scale (SUS) score was used to assess patient usability experience. Raw SUS scores were dichotomized (≥72% or <72%) to determine app usability against a 75% a priori criterion for mean APP group score. Feasibility for app use was similarly evaluated in the APP group only through a priori criteria applied to computing device ownership and study use, to the absence of technology-based barriers to participation, and to completion of app-based testing. Exploratory measures compared change from baseline to 30 days for functional and patient-reported outcomes between APP and CONTROL. Results: The APP group’s mean SUS score of 79.2% at 30 days exceeded the 75% threshold for good usability. The app met the predetermined a priori feasibility criteria for absence of technology-based barriers to participation (75% of participants) and completion of app-based testing (91.3% of participants). Personal computing devices were used by 71.4% of APP participants, which was below the 75% a priori feasibility criterion. No differences between the APP and CONTROL groups were observed for functional or patient-reported outcomes. Conclusions: The app-based platform met the a priori criteria for usability for 79% of APP participants. Our findings suggest that app-based, avatar-guided home exercise after TKA has acceptable usability and feasibility. The app-guided patient assessment capability also demonstrates preliminary feasibility for guiding and administering functional and self-reported outcomes assessments.

Novel miniature mobile cardiac catheterization laboratory for critical cardiovascular disease following natural disasters： a feasibility study

Background Natural disasters have been frequent in recent years. Effective treatment of patients with cardiovascular disease following natural disasters is an unsolved problem. We aimed to develop a novel miniature mobile cardiac catheterization laboratory （Mini Mobile Cath Lab） to provide emergency interventional services for patients with critical cardiovascular disease following natural disasters. A feasibility study was performed by testing the Mini Mobile Cath Lab on dogs with ST-elevation myocardial infarction （STEMI） model in a hypothetical natural-disaster-stricken area. Methods The Mini Mobile Cath Lab was transported to the hypothetical natural-disaster-stricken area by truck. Coronary angiography and primary percutaneous coronary intervention （PCI） were performed on six dogs with STEMI model. The transportation and transformation of the Mini Mobile Cath Lab were monitored and its functioning was evaluated through the results of animal experiments. Results The Mini Mobile Cath Lab could be transpdrted by truck at an average speed of 80 km/h on mountain roads during daytime in the winter, under conditions of light snow （-15℃ to -20℃/-68°F to -59°F）. The average time required to prepare the Mini Mobile Cath Lab after transportation, in a wetland area, was 30 minutes. Coronary angiography, and primary PCI were performed successfully. Conclusion This preliminary feasibility study of the use of the Mini Mobile Cath Lab for emergency interventional treatment of dogs with STEMI indicated that it may perform well in the rescue of critical cardiovascular disease following natural disasters.

Possibilities for Healthcare Computing

Advances in computing technology promise to aid in achieving the goals of healthcare. We review how such changes can support each of the goals of healthcare as identified by the U.S. Institute of Medicine： safety, effectiveness, patient-centricity, timeliness, efficiency, and equitability. We also describe current foci of computing technology research aimed at realizing the ambitious goals for health information technology that have been set by the American Recovery and Reinvestment Act of 2009 and the Health Reform Act of 2010. Finally, we mention efforts to build health information technologies to support improved healthcare delivery in developing countries.